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Sleep Medicine : What Ayurveda Can Contribute ?

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Sleep Medicine : What Ayurveda Can Contribute ?

  1. 1. Sleep Medicine : What Ayurveda Can Contribute? Prof. Sanjeev Rastogi State Ayurvedic College and Hospital, Lucknow
  2. 2. When This is Dark What comes to our mind first Let’s Sleep………Its time to sleep
  3. 3. Sleep Has a Dark Connection  From evolutionary biological perspectives day light allows us to get involved in activities essential for survival  Food Procurement  Defense  Observed in plants also  Heliotropic movements  Photosynthesis  Almost every physiological activity in a living cell has a circadian rhythmicity responding to dark and light cycle of nature
  4. 4.  Biological clock works in unison with natural clock  The trigger for setting of the biological clock in tune to natural clock is Dark and light  Besides circadian, there are ultradian rhythms too which govern our entire physiology The Two Guiding Clocks Biological Clock Natural Day Night Clock
  5. 5. Hormones Status in Day Status in Night Function Cortisol ↑ ↓ Defense Insulin ↑ ↓ Glucose Metabolism Leptin ↓ ↑ Appetite suppression Ghrelin ↑ ↓ Appetite enhancer Testosterone ↓ ↑ Sex drive , Sperm Quality Melatonin ↓ ↑ Sleep induction Tuning of Biological Clock to Natural Clock
  6. 6.  Our temporal physiology and behavior is primarily regulated by the circadian pace maker located in the hypothalamic supra-chiasmatic nucleus (SCN)  Rhythms are generated in cells by auto-regulatory transcription/translation feedback loop, composed of several clock genes and their protein products.  Clock genes produce proteins in rhythm with the planet’s daily rotation from light to dark  Clocks operating in cells are fundamental to health  When clocks are disrupted, metabolic disorders can develop How This All is Regulated?
  7. 7. Disharmony of Clocks : The Cause of All Evils ?
  8. 8.  ब्राह्मे मुहुर्ते उत्तिष्ठे जीर्ााजीर्े निरूपयि - Get up early in the morning  कालस्र्तथोचिर्त: निद्रा Timely and adequate sleep  Ayurveda severely criticizes attempts of creating disharmony between biological and natural clock  रात्रि जागरर् (Night awakening) - रुक्षं Increases vata  दिवास्वप्ि ( Day time sleep) - स्स्िग्धं Increases kapha  रात्रि जागरर् and दिवास्वप्ि are contraindicated  In general  In respective dosha predominance people and pathology  रात्रि जागरर् and दिवास्वप्ि are presumed cause of many diseases related to respective dosha ( including Diabetes) Ayurvedic Perception of Biological Clock in Tune to the Natural Clock
  9. 9.  Protect our selves in dark …. ?  Give rest to our mind…. ?  Give rest to our body ……..? Why Do We Sleep ..?  यिा र्तु मिसि क्लान्ते कमाात्माि: क्ल्मास्ववर्ता:। त्तवषयेभ्यो निवर्तावर्ते र्तिा स्वत्तपनर्त मािव:॥ ि.िू.२१/३५  When mind is tired , the sense organs also get fatigued hence fail to receive the stimulus , a man then sleeps .  Sleep is an active process cleaning our brain of all junk though a specific pulsatile glymphatic mechanism which pumps out toxins from brain to neck lymphatic system.
  10. 10.  निद्रा is One of the three fundamental foundations of life called ियोपस्र्तम्भ  As important as  आहार  ब्रह्मिया not the celibacy निद्रा ब्रह्मिया आहार Life is completely dependent upon these three and in the absence of any of them, it can not exist Ayurvedic Wisdom About Sleep
  11. 11. निद्रायर्तं िुखं िु:खं पुस्ष्ि कार्शया बलाबलम । वृषर्ता क्ललीवर्ता ज्ञािमज्ञािं जीत्तवर्तं ि ि॥ ि.िू.२१/३६  िुखं िु:खं  Happiness and Sorrow  पुस्ष्ि कार्शया  Nourishment and Emaciation  बलाबलम  Strength and Debility  वृषर्ता क्ललीवर्ता  Virility and Impotence  ज्ञािमज्ञािं  Knowledge and Ignorance  जीत्तवर्तं ि ि  Life and No life A Contrasting combination of features that are produced in the presence or absence of good sleep Systemic Effects of Sleep
  12. 12. िुख िंज्ञकम आरोग्यम, त्तवकारो िु:खमेव ि।  Sleep disturbances are there in most physical and mental diseases either as a cause or a manifestation  Sleep is the primary indicator of quality of life  Sleep is also the primary indicator of healing process.  Sleep plays an important role in pain perception Sleep Pain Sleep as an Inductor to िुख - िु:ख
  13. 13.  Ayurveda believes that sleep promotes nourishment (बृंहर्) and hence promotes weight gain in general  Sleep is recommended as a therapy for the emaciated people  स्वप्िो हषा िुख शय्या.....ि.िू.२१/२९  Those who wish to gain weight are advised not to remain awake in night  प्रजागरं व्यवायं ि व्यायामं चिवर्तिानि ि।स्थौ्यम इच्छि पररत्यक्लर्तर्तुं क्रमेर्ासभ प्रवधायेर्त………..ि.िू.२१/२८  Hypersomnia is considered as one important cause of obesity  अचिवर्तिाच्ि कायाार्ां ध्रुवं िवर्तपार्ेि ि। स्वप्ि प्रिंगाच्ि िरो वराह इव पुष्यनर्त ॥ ि. िू.२१/३४ Sleep as promoter to Nourishment and Debility (पुस्ष्ि / कार्शया)
  14. 14.  Sleep is an important neuroendocrine and glucose metabolism modulator  Sleep loss results in metabolic and endocrine alterations like : ↓ glucose tolerance, ↓ insulin sensitivity, ↓ levels of Leptin, ↑evening level of cortisol, ↑ Ghrelin, and ↑ hunger and appetite.  sleep loss has ↑ risk of obesity. This evidence is contrary to the ayurvedic concept of sleep restriction as a promoter to weight loss Sleep and Obesity: Current Evidences
  15. 15. • Sleeping less or more both lead to obesity • Sleep loss is associated with increased appetite and hunger • This may be the indirect cause of increase in weight among people who sleep less Sleep: A Double Edged Effect
  16. 16. • Sleep is an immune booster. • Sleep enhances the immune related memory . • Sleep promotes production of undifferentiated T cells and pro- inflammatory cytokines बल-अबल Sleep and Immune Function
  17. 17. Sleep as inductor of Virility and Impotence वृषर्ता क्ललीवर्ता
  18. 18. • Sleep ↑ the testosterone levels and waking ↓ it. • Testosterone and other steroid hormone levels are linked with sexual drive and performance . • Sperm Motility decreases in less sleep and also in over sleep • Sperm Count decrease in less sleep and also in over sleep ∩ Sleep as Inductor of वृषर्ता क्ललीवर्ता
  19. 19. Sleep deprivation affects cognitive functions negatively Neuropsychiatric Disease and Treatment 2007:3(5) 553–567 Enhanced problem solving skills after sleep are not merely associated with mitigation of interference in concentration but is actually related to the mechanism of spreading activation in neurons (recruiting more neurons for a set of problems) Sleep as an Inductor of ज्ञाि - अज्ञाि
  20. 20.  अनिद्रा is caused by कु त्तपर्त वायु  निद्राचधक्लय is the result of कफ वृद्चध  Management plan for अनिद्रा is to ↓ वार्त and ↑ कफ 1. मदहषी क्षीरं स्वप्ि जििािां श्रेष्ठ: ि.िू. २५/४० 2. निद्रा घार्ते त्तपबेर्त क्षीरं स्वप्याच्िेष्ि कथो िर: िु.उ.र्तं. ५५ 3. निद्रात्तवधारर्ार्त र्ति स्वप्िं िंवाहिानि ि॥ ि.िू. ७/२३ Ayurvedic Proposals for Managing Sleep Disorders Milk specially the buffalo milk and body massage are considered effective treatment for insomnia
  21. 21. • Milk is a rich source of Tryptophan, an essential amino acid • Tryptophan is a precursor for serotonin which in turn converts to melatonin. • Serotonin and Melatonin both are known to enhance sleep and to relax the brain. • Milk is also a direct source of Melatonin Milk as a Sleep Inducer
  22. 22. Milk produced in night time when this is dark is exceptionally rich in melatonin , the sleep inducer hormone Night Time Milk or Milk in Night Time ?
  23. 23. अभ्यंगोत्िाििं स्िािं ग्राम्यािूपौिका रिा: । शा्यविं ििचधक्षीरं स्िेहो मद्यं मि:िुखम॥ मििो अिुगुर्ा गवधा: शब्िा: िंवाहिानि ि। िक्षुषोस्र्तपार्म लेप: सशरिो वििस्य ि ॥ स्वास्र्तीर्ा शयिं वेर्शम िुखम कालस्र्तथोचिर्त: । आियवत्य चिरास्विद्रां प्रिष्िा या निसमत्ि:॥ ि.िू.२१/५२-५४ Ayurvedic Management for Insomnia The idea is similar to the concept of sleep hygiene It promotes practices and habits helpful in having a good night time sleep and full daytime alertness
  24. 24.  अभ्यंग Massage  उत्िािि Rubbing  स्िाि Bath  ग्राम्य आिूप औिक रि Kapha promotive food  शा्यवि ििचध क्षीरं स्िेहो Kapha promotive  मद्यं मि: िुखम  मििो अिुगुर्ा गवधा: शब्िा: Good aroma , light music  िंवाहि Kneading Massage  िक्षुष र्तपार् covering the eyes  सशरोलेप Head massage  काय लेप Body rub and paste  स्वास्र्तीर्ा शयिं वेर्शम िुखम comfortable bedding and linen  कालस्र्तथोचिर्त: timely and adequately Ayurvedic Wisdom of Sleep Induction and Sleep Hygiene
  25. 25.  Putting oil on scalp may induce sleep  निद्रालाभ: िुखं ि स्याि मुस््िा र्तैलनिषेवर्ार्त’ ि.िू.५/८३  Current evidences are suggestive of beneficial effects of head and body oil massage in infants resulting in:  Improved Growth  Improved Sleep pattern  Improved Sleep duration  Improved Sleep Quality Scalp Massage for Insomnia
  26. 26. Increases serum serotonin level Produces meditation like state Increases delta waves in brain Has anti anxiety effect सशरोधारा for the Management of Insomnia
  27. 27.  Ayurveda takes a due cognizance of natural and biological clock and recommends the person to behave accordingly  Ayurveda considers sleep as one essential condition of life .  Ayurveda recognizes the systemic effects of sleep besides its relaxing effects  Ayurveda criticizes the attempts to disharmonize natural clock and biological clock and hence it criticizes night awakening and day nap.  Ayurvedic treatments for insomnia are in tune to the idea of sleep hygiene and are better than later at many places  Simple remedies like head massage with oil and oil based shirodhara are effective in sleep loss. Key Message

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