Ayurvedic Management of Insomnia
/
"As wholesome diet is needed for the body, so is sleep. Obesity and leanness are particularly caused by sleep and diet." (1)
"Yoga is not for those who sleep too much, nor for those who stay awake too long" (2)
The Ayurvedic texts and Bhagavad Gita attest to the value and necessity of sleep for health, longevity and spirituality; facts supported by contemporary research linking insomnia to a range of conditions including obesity, heart disease, diabetes, mood disorders and car accidents (3). "Dependent on sleep are happiness and misery, corpulence and leanness, strength and weakness, potency and impotency, intellect and non-intellect, life and death." (4)
Yet chronic insomnia is a widespread and common disorder affecting 10% to 15% of adults, with an additional one third of all adults experiencing transient or occasional insomnia (5, 6). Patients suffering from insomnia frequently present for Ayurvedic care, feeling dissatisfied with long term prescriptions for sleeping pills.
Currently accepted causes of insomnia include such vatagenic factors as irregularity of schedule, use of caffeinated beverages, particularly in the afternoon, excess exercise at bed time, disorders causing pain or nocturnal urination, and excess anxiety and stress. Sleep disorder is also more common in elders (i.e. in the vata time of life) affecting up to 47% of the elderly population (7). This concurs well with the Charak Samhita, "Fear, anxiety, anger, smoking, exercise, blood-letting, fasting, uncomfortable bed...these very factors may be taken as causes of insomnia, along with overwork, old age, vatika disorders and aggravation of vata itself." (8)
Although, as the texts indicate, there is always an important vata component in insomnia, we typically distinguish between vata and pitta types of insomnia. Pitta-type insomnia occurs in the pitta time of night, from ten at night to two in the morning and so is usually experienced as difficulty falling asleep. The mind is intense and overactive and it is difficult to relax. Instead, pitta may lay awake making mental lists and thinking of things that need to get done. Pitta insomnia may be related to working late at night, using the computer too late, trying to cram too many activities into the evening, or simply staying up too late. Much as "early to bed, early to rise" is an ideal Ayurvedic lifestyle, this goal may be unattainable for busy parents. As one pitta reported, "It takes until nine to get my son to bed, and then I need some time to say at least a few words to my husband and some time to get ready for bed." However, as a general rule, computer work should end no later than nine thirty, since computer screens provoke alochak and sadhak pitta and disturb tejas, especially when used in the pitta time of night. For pitta types who can't accomplish the ideal of actually getting to sleep in the kapha evening time, it is at least often feasible to make ten o'clock an official bedtime, with no more work or stimulating activities after that time. Lights should be low, and pitta can take time to relax, sip some soothing tulsi and coriander tea or some warm milk with cardomon and massage the soles of their feet with Bhringaraj oil. Valuable herbs to help pitta get to sleep include bhringaraj, passionflower, skullcap, Guduchi and chamomile, all of which are found in the I Sleep Soundly formulation. . Sarvangasana is good for pitta insomnia, while Shitali, nadi shodan/anuloma viloma and yoga nidra are invaluable.
Work-related items, including computers, cell phones and papers should be kept out of the bedroom, so that the sleeping space becomes a peaceful retreat from the busyness of the day. A student or other person obliged to live and study or work in the same small space can still screen off a quiet area kept only for sleep. Pitta needs to avoid exposure to bright light for the entire duration of the night, so a bathroom night light is helpful to remove the need of turning on the light. Pitta is extremely light-sensitive and may need thick curtains to cut out the light from street lamps. Electronic devices with little red or green lights should be unplugged during sleep.
Pitta insomnia may occur with general pitta provocation, such as in the premenstrual days, or may be symptomatic of pitta type depression. For insomnia accompanying pitta depression, daily use of Nasya Oil, Brahmi tea during the day and brahmi milk at bed time will be helpful. Note that pitta insomnia may also be secondary to acid reflux or amlapitta. The upward movement of doshas in reflux is not conducive to good sleep, nor is the associated discomfort. For reflux-related insomnia, Licorice and fennel tea is often very helpful. Also, pitta individuals often find that they sleep better if they take a cup of bhumyamlaki tea at bed time, which helps prevent acid reflux and calms the liver energy. It is best for pitta to take extra care to eat pitta soothing foods in the evening and to take a light dinner at least three hours before bed time.
Vata insomnia occurs in the vata time of night, the 'wee small hours'. A typical vata insomniac complains of restless sleep, tossing and turning, or waking between two and four in the morning. Often it is impossible to get back to sleep until sunrise ushers in the heavy energy of the kapha time of morning. Vata insomnia may be greatly worsened by vata's inherent tendency to irregular habits. A regular bed time is essential for the vata insomniac...yet the favoured vata bed time of two in the morning will never lead to a good night's sleep, even if vata did get a lot of wonderful artwork or music recording done while everyone else was asleep! Other vatas let their restlessness get the better of them by waking to watch movies when they have difficulty sleeping. Once the lights have gone out at night, it is important to avoid bright or artificial lights for the rest of the night. Prior to the advent of electric lights, our ancestors had no opportunity to get into bright light during the night. If vata wakes at night, they should rest in bed and do yoga nidra rather than get up and move around. Television should not be used in the bedroom. In general, the programming offered is more likely to stimulate adrenalin secretion than to provide genuine relaxation. Bed time reading can also disturb vata--thrillers and murder mysteries are not soothing whereas a paragraph or two of a spiritual book can help bring good dreams. Vata is sensitive to electromagnetic fields and should not sleep near an electrical outlet or electronic device.
"Massage, anointing, bath...rice with curd, milk, fat, wine, pleasant smell and sound, gentle rubbing...well covered bed, comfortable room and proper time--these bring shortly the sleep which is disturbed by some factor." (9) As the text suggests, daily abhyanga with vata massage oil is extremely helpful in vata insomnia. In addition, vata can massage the soles of the feet with Bhringaraj oil at bed time, and can also anoint sthapani marma (the third eye), simanta marma (anterior fontanel) and adipati marma (vertex) with Bhringaraj oil at night. Shirodhara with Shirodhara oil is beneficial, particularly because of the heavy quality of sesame oil.
Insomnia is associated with the chala, laghu, and vishada qualities of vata and so is best managed by foods and herbs having sthira, guru and avila qualities. Milk fits this description excellently. A cup of warm milk with cardomon, cinnamon and ghee is a good bed time drink for vata. Better still; a teaspoon of Ashwagandha can be stirred into this warm spiced milk. Daily Nasya oil is also helpful in vata insomnia. Herbs such as valerian and nutmeg, which have the heaviness of tamas guna, are valuable for sleep, while the major vata soothing herbs, Ashwagandha and Vidari, are also needed in a sleep formula for vata. These key herbs for vata insomnia are found in the I Sleep Soundly formula, a good all round formulation for vata, pitta and dual-doshic forms of insomnia. Yoga practice for vata insomnia should emphasize sthira rather than chala energies, with an emphasis on asanas that bring stability and balance, and on holding poses for longer and entering into the asana more deeply. Rough, light and astringent foods such as salads and rice cakes should be avoided, especially at night. A comforting soup is a good light dinner for vata.
Vata insomnia is often a simple manifestation of a vatagenic lifestyle or general vata provocation, but it may also be an important symptom of vata depression, anxiety disorder, chronic fatigue syndrome of vata type, or PTSD (Post traumatic stress disorder). For these major conditions, deeper measures such as pancha karma are indicated.
Although kapha is not in itself related directly to insomnia, but rather to excess sleep, there are a number of kapha conditions which can lead to poor sleep. These include prostatic hyperplasia, which can disturb sleep because of nocturnal urination, asthma, which disturbs sleep because of breathing difficulties at night, and sleep apnoea, a significant cause of insomnia particularly in elderly, obese men with type II diabetes. (10) When elders of kapha prakruti or vikruti complain of insomnia, it is advisable to look into these possible primary conditions and provide appropriate chikitsa.
As we have seen, simple lifestyle measures and use of appropriate oils and herbal remedies such as I Sleep Soundly will be effective in many cases of insomnia. At the same time, the practitioner should look deeper to determine whether the insomnia is a primary condition or a secondary manifestation of a significant illness which must be managed in its own right.
Charak Samhita Sutrasthana xxi 51 tr. PV Sharma Chaukhambha Orientalia 1994
Bhagavad Gita, ch. 6 v. 16 author's rendition
Sleep disturbances and chronic disease in older adults Results of the 2003 National Sleep Foundation Sleep in America Survey. Journal of Psychosomatic Research, Volume 56, Issue 5, Pages 497 - 502 D . Foley, S. Ancoli-Israel, P. Britz, J. Walsh
Charak Samhita Sutrasthana xxi 36-37 tr. PV Sharma Chaukhambha Orientalia 1994
Roth T. New developments for treating sleep disorders. J Clin Psychiatry. 2001;62(suppl 10):3-4.
National Heart, Lung, and Blood Institute Working Group on Insomnia. Insomnia: assessment and management in primary care. Am Fam Physician. 1999;59:3029-3038
Foley DJ, Monjan AA, Brown SL, Simonsick EM,Wallace RB, Blazer DG Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep1995; 18:425-432
Charak Samhita Sutrasthana xxi 55-57 tr. PV Sharma Chaukhambha Orientalia 1994
Charak Samhita Sutrasthana xxi 52-54 tr. PV Sharma Chaukhambha Orientalia 1994
Smith S, Sullivan K, Hopkins W, Douglas J Frequency of insomnia report in patients with obstructive sleep apnoea hypopnea syndrome Sleep Med 2004;5(5):449-56.
All products mentioned in this article are available from www.banyanbotanicals.com.
Alakananda Ma M.B., B.S. (Lond.) is an Ayurvedic Doctor (NAMA) and graduate of a top London medical school. She is co-founder of Alandi Ayurveda Clinic and Alandi Ayurveda Gurukula in Boulder Colorado, as well as a spiritual mother, teacher, flower essence maker and storyteller. Alakananda is a well known and highly respected practitioner in the Ayurveda community both nationally and internationally.
Enliven your holistic health! Visit Alakananda Ma in Alandi Ashram’s ayurvedic clinic to support the overall rejuvenation of your body, mind, and spirit. In-person and virtual appointments available. Book now!
