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Vedic description of insomnia

The best description of the causes and treatment of insomnia comes from Vidura Niti a dialogue between Vidura and Dhritasashtra, said Dr KK Aggarwal President Heart Care Foundation of India and Director IMAAKN Sinha Institute. .

Vidura said: “Sleeplessness overtakes thief, a lustful person, him that has lost all his wealth, him that has failed to achieve success and him also that is weak and has been attacked by a strong person”.

He therefore described five basic reasons for insomnia and even in today’s science they are true. No new cause has been added in this list of stress induced insomnia.

The situations are:

1. A thief

2. A lustful person

3. A person who has lost all his wealth

4. A person who has failed to achieve success

5. A person who is weak and has been attacked by a strong person.

Ayurveda describes sleeplessness as an aggravation of vata & pitta dosha. The number one cause of the same is mental tension; suppressed feelings & acute bitterness. The above five situations again hold true to this effect.

Apart in allopathy other causes of insomnia mentioned are constipation; dyspepsia; excessive intake of tea, coffee & alcohol and environment Factors-excessive cold, heat or change of environment. They are in most of the situations the effect and not the cause of insomnia.

The treatment of insomnia involves either suppressing the emotions with drugs or root level eradication of stress with proper counseling.

Bhagwad Gita, Chanakya Nitiu and Vidu Noti are all the high level counseling books of ancient era and provide texts and sutras even true today. Bhagwad Gita was a counseling when Arjuna went in an acute anxiety state and was not being able to decide whether or not he should fight with his near ones. He said: my legs are trembling, my bows are leaving me, by body is shaking, what should I do”. The principles of Gita today are incorporated as the principles of Bhagwad Gita and they are minimal 18 counseling sessions, second and last session the longest, in the first session only listen, reassure the person repeatedly.

Chanakya again gave principles of how to manage conflicts and win over others by way of different principles. One of his main teachings was that money earned by unfair means can only last for eight years.

Here are some of the sutras of Vidura Niti

Do not inhabit a surrounding where you are not respected, cannot earn your livelihood, have no friends, or cannot acquire knowledge. (1.8)

Do not reveal what you have thought upon doing, but by wise counsel keep it secret, being determined to carry it into execution. (2.7)

Consider again and again the following: the right time, the right friends, the right place, the right means of income, the right ways of spending, and from whom you derive your power. (4.18)

A wise man should not reveal his loss of wealth, the vexation of his mind, the misconduct of his own wife, base words spoken by others, and disgrace that has befallen him. (7.1)

One of the answers to insomnia is learning meditation as described in Patanjali Yoga Sutra or Yoga Vashistha. It is based on the principle of concentrating on the present, which shifts the inner environment from sympathetic to para sympathetic mode. 20 minutes of meditation morning and evening provides the same biochemical benefit as gathered from 7 hours of deep sleep

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By : KASMIAH MUSTAPHA

2009/03/23

Most of us would have experienced an inability to sleep at some point in our lives. KASMIAH MUSTAPHA talks to an expert to find out the causes.

IT’S 3am and Adam has been tossing and turning throughout the night. He has been trying hard to go to sleep but can’t seem to do it. Even if he does fall asleep, he will be awake 10 minutes later.

Adam has been suffering from this sleeping disorder for months. Insomnia is the most common sleeping disorder; most of us would have faced this problem at some point of our lives.

Some people only suffer from it for a short term and will be back to normal in no time, while others require professional help.

Symptoms include difficulty in falling asleep, waking up often during the night and having trouble going back to sleep, waking up too early in the morning and feeling tired upon waking.
Research has found that insomnia is a persistent condition for many people. About 75 per cent of those with insomnia experience the condition for at least a year, and almost half experience it for three years.

Darul Ehsan Medical Centre consultant physician and cardiologist Col (R) Dr Abd Rahman Mohd Ali said when insomnia leads to problems such as lethargy, fatigue, inability to concentrate and low quality of life, one has to seek treatment.

“For some people, worrying about their health, financial situation and work can result in them not being able to sleep for days, weeks or even months. Once they are deprived of sleep, they may face other problems.

“In Adam’s case, a family member had died of cancer. He began to worry that he too had cancer. Even a slight pain had him rushing to the doctor as he was convinced that he will die of cancer. The worry, stress and fear kept him awake.”

Dr Abd Rahman said disturbed sleeping patterns can also lead to insomnia.

“If the time you go to sleep is constantly changed, the body will find it difficult to adjust after a while and you will start having sleepless nights.

“We need to maintain a regular bedtime. If you usually go to sleep at 11pm and wake up at 6am, you need to keep to it. You shouldn’t sleep late or wake up late because your biological clock has been set. If you sleep late, you tend to oversleep, and this pattern can go on for days.”

A recent study in the United States found that almost a third of all Americans suffer from insomnia because they are worried about the economy, their jobs or finances.

The study also found that those whose sleep is affected are less likely to work efficiently, exercise and eat healthily.

In the study, 27 per cent of those surveyed said they had disturbed sleep in the past month due to money issues — including personal finances (16 per cent), the economy (15 per cent) or losing their jobs (10 per cent).

The study also revealed that insomnia is more common among females, especially menopausal women, due to hormonal changes.

People with a medical condition will also face difficulty in sleeping. Those who are suffering from asthma, diabetes, prostate problems, arthritis, depression and anxiety are prone to insomnia.

Dr Abd Rahman said if a person is sleep deprived, it will affect his concentration and work which, in turn, will have consequences on his social and economic life. Lack of sleep will also increase certain conditions such as hypertension, diabetes, stress, heart disease, headache and depression.

The treatment for insomnia usually begins with changing one’s lifestyle and behaviour. In many cases, doctors would not prescribe medication for treating it as it can lead to addiction, said Dr Abd Rahman.

“People who suffer from insomnia must maintain good hygiene and good sleeping habits including maintaining a conducive environment in their bedroom.

“Make sure your bedroom is purely for sleeping. For some people, their bedrooms also double up as their office with laptops, TV sets and such.”

There are also those who are not opposed to eating in bed. They make the bedrooms not conducive to a good night’s sleep.

Another no-no is taking long naps during the day.

“If you feel sleepy, take a short nap between 10 and 15 minutes after lunch. Do light exercises at least four hours before you go to bed and try not to have a heavy meal close to your bedtime.”

Caffeine, nicotine and alcohol should be avoided late in the day. Caffeine and nicotine are stimulants which will keep us from falling asleep while alcohol can cause waking in the night and interferes with sleep quality.

If you are not sleepy, have a warm bath or drink that will help you relax or read a book that you know will help you fall asleep.

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By Cindy Pan and Leah Hechtman

March 22, 2009 12:00am

DIFFICULTY in falling asleep is a fairly common problem with around one in five people suffering from poor quality or quantity of sleep at some point in their lives.

To re-establish healthy sleep habits try to wake up at the same time each morning, avoid napping and go to bed around the same time every night. Minimise caffeine intake, especially after 4pm.

Excessive alcohol can also cause sleep disruption and decreased deep sleep.

Avoid exercising or eating large meals in the hours before bed and try to establish a regular bedtime routine that helps you wind down, such as having a bath or listening to soothing music.

Sleeping pills should be avoided as far as possible, so talk to your doctor first about whether short term or occasional use of sleeping medication would be appropriate in your case. – Dr Cindy Pan

The vicious cycle of insomnia is awful. Insomnia is often the end stage of longstanding exhaustion and stress, and indicates the body needs repair.

The first priority is to establish a regular sleeping routine. Literally forcing yourself to wake at the same time each day will promote regulation of your sleep-wake cycle.

Even though it is hard at first, get up at sunrise and go for a walk!

Avoid foods that contain tyramine, such as citrus fruits, red wine, cheese and chocolate, as well as alcohol, caffeine and tobacco.

Foods rich in the amino acid tryptophan, such as turkey and tuna, help induce sleep. Useful herbal remedies include chamomile, valerian and passionflower. – Leah Hechtman

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12:32 pm March 10, 2009, by Charles Yoo

 By David Schulman, MD, MPH

Every night, thousands of Atlantans have difficulty falling asleep. In some cases, the problem will be severe enough that they will seek medical advice, though many more will choose not to, believing either that the problem isn’t that big, or that there aren’t any effective therapies available. Others end up using either prescription or over-the-counter sleep aids on a regular basis. That may come with its own set of problems.

When a patient comes to my clinic, I begin the evaluation by looking at three key components of the bedtime process: the environment, evening behaviors and patient attitudes. Are the bed and pillow comfortable? Is the bedroom dark, quiet and cool (People tend to sleep better in cooler weather; making sure the ambient temperature is dropping around bedtime can often improve sleep quality). Are there other noises in the area, coming from outside or the person in bed next to you?  Correction of these factors does not require much work and can often improve symptoms of insomnia.

But, some insomnia patients engage in behaviors before bedtime that make it harder to sleep. A large meal within one-to-two hours, exercise within three hours and caffeine within 12 (!) hours of bedtime can all contribute to difficulty falling asleep.  Another common mistake is to use television or a computer just before going to bed – such activities can make your body more alert and cause insomnia. I am constantly amazed at the number of people who leave the television on to help them fall asleep, in almost all cases, this does more harm than good.

I spend a great deal of time focusing upon the attitudes of patients as they approach bedtime. Depression is very common amongst people with insomnia, and treatment of the underlying mood problem can improve sleep quality. Is my patient nervous or anxious? Often, underlying stress can be the major contributor to poor sleep, even if the affected individual doesn’t feel “stressed out” during the day. Indeed, many patients with chronic insomnia begin to see their bedrooms as a stressful place, and going to bed each night becomes a chore. These attitudes contribute further to anxiety, making insomnia even more likely. Breaking this cycle is a key component of the treatment of insomnia.

Treating insomnia with medication is common. The National Sleep Foundation says that 25 percent of Americans take some type of medication at least once per year to help them sleep. While occasional use of such medications is likely to be safe, the regular need for sleep aids may suggest an underlying sleep or mood disorder that should be evaluated by a specialist. The use of non-prescription sleep aids such as melatonin and valerian is also quite common. It is important to remember that these compounds are not regulated by the Food and Drug Administration, and their effectiveness or safety has not been reliably demonstrated.

Why is all of this important? There is growing evidence that sleeplessness can contribute to illness such as diabetes or heart disease, and many problems can arise when someone has not gotten a good night’s sleep – such as falling asleep while driving or while on the job. We all want to be as healthy as we can – eating right, exercising – and I can tell you that getting a good night’s sleep is just as important to overall health. If you have regular sleep problems, discussing this problem with your doctor may be the first step to finding a solution.

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You close your eyes and feel yourself drifting into a peaceful doze. However, when your eyes flick open after what feels like hours of shuteye, you discover with horror that only a few minutes have ticked by. As you struggle to make yourself more comfortable, a thought runs through your mind, "Do I have insomnia?"

If you have trouble sleeping, you are by no means alone. Thomson Reuters recently reported that between 1998 and 2006, use of sleep aids by college-aged students (aged 18 to 24) increased by almost 40 percent. Though 599 young adults per 100,000 used sleep aids in 1998, the study found 1,524 per 100,000 did so in 2006.

A study presented at the 22nd Annual Meeting of the Associated Professional Sleep Societies in June has linked insomnia in college-aged students to a lower GPA. Seventy percent of students who were classified as having a low GPA also reported that they had trouble falling asleep. At night, 53.1 percent of those students had leg kicks or twitches while 65.6 percent woke and then had trouble falling back asleep. Seventy-three percent of the low GPA students found concentration difficult.

In addition to affecting grades, insomnia can have more severe effects. In another recent study, 19-24-year-old undergraduates with poor sleep quality or insomnia displayed heightened suicidal symptoms even when controlling for depression.

Do I have insomnia?

Insomniacs are individuals who have difficulty falling asleep, remaining asleep, wake up too early, and/or feel tired when they wake. Symptoms may include feeling sleepy during the day, general fatigue, irritability, and problems with concentration or memory. Approximately 30 percent of the adults show symptoms of this most common sleep disorder.

Insomnia can have many causes: illness, emotional or physical pain, depression, anxiety, stress, medications, substances like alcohol or caffeine, a poor sleep environment, or an unsettled sleep schedule.

Complications of insomnia include poor job or school performance, delayed reaction times, psychiatric problems, obesity, an impaired immune system, and the increased risk of long-term diseases such as heart disease and diabetes.

What can be done?

The American Academy of Sleep Medicine (AASM) suggests a few ways to sleep restfully:

-Avoid rigorous exercise, stimulants (e.g., caffeine and nicotine), alcohol, and large meals late in the day.

-Do not go to bed hungry, either.

-Make sure that your bedroom is dark, quiet, and a comfortable temperature.

-Follow a set bedtime routine and let go of the day’s stressors before bed.

-Sleep the recommended seven to eight hours a night.

-Wake up at the same time every day.

If following the AASM’s tips for getting a good night’s sleep does not improve your condition, schedule an appointment with a sleep specialist or physician. Individuals with mild insomnia will most likely be told to engage in healthier sleep practices. Once diagnosed, acute insomnia (symptoms lasting one night to a few weeks) can be treated for a short time with sleeping pills. Chronic insomnia (symptoms lasting three nights a week to months or more), on the other hand, requires treatment of underlying problems or health concerns. Behavioral therapy may be advised as a way to learn proper sleeping and relaxation techniques.

By Elizabeth Silberholz can be contacted by using our contact form and selecting the section this article was written for.

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A recent study I read showed some interesting aspects about the sleep of our friends to the north, and they seem to be as bad as ours here in the US! The study recently published in the journal Sleep explained the economic cost associated with sleep disorders in Canada. Here are the bullets (all in Canadian $):

• total annual cost of insomnia (direct and indirect) in the province of Quebec was estimated at $6.6 billion
• prescription medications ($16.5 million)
• over the-counter products ($1.8 million)
• alcohol used as a sleep aid ($339.8 million)
• The total estimated annual cost of alcohol used for promoting sleep was $51.1 million spent by people with insomnia syndrome, $211.2 million by those with symptoms of insomnia and $77.5 million by good sleepers.

What everyone seems to be making a big deal about is the alcohol consumption number.  My question is WHY?

Sleep researchers for YEARS have known that the #1 sleep aid in the world is alcohol. If you go back to the 1998 Sleep In America Poll, you find that 10% of all Americans had used alcohol in the past year to "help" with sleep. Another study collected in the Detroit area showed that 13% of those polled used alcohol as a sleep aid.

Let’s do some math here. There are approximately 7.5 M people in the Province of Quebec. If we took the percentage of people we know in the US who use alcohol as a sedative (say 10%) and said those 750,000 account for the $340 million spent on alcohol as a sleep aid, that equals 453 dollars per person. If you have symptoms of sleep problems 4 nights a week and 50 weeks a year that is about $2.27 per night, or a beer or two.

What is important here is that the number was 20 times more than prescription medication, and 188 times more than OTC products for sleep. And we wonder why pharmaceutical companies keep introducing new insomnia medications? 

Don’t get me wrong, I am a very large proponent of natural, non-pharmaceutical methods for helping with sleep (Cognitive Behavior Therapy, Sleep Hygiene, Sleep Supplements, etc.). But it looks like people are looking for better answers to a better night’s sleep, and let me tell you alcohol is not the answer.

Alcohol, in large quantities, while making you sleepy, keeps you out of the deep stages of sleep, makes you dehydrated, and wakes you in the middle of the evening (usually to go to the bathroom). So the moral of the story is a glass of wine with dinner may be fine, but a six pack is not a good bedtime story.

Sweet Dreams,
The Sleep Doctor

This article on sleep is also available at Dr. Breus’s official blog, The Insomnia Blog.

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11:00 AM CST on Thursday, January 8, 2009

McClatchy Newspapers

The National Sleep Foundation’s latest Sleep in America Poll indicates that about two-thirds of adults experience trouble sleeping at least one night a week, while almost one-half report sleep problems almost every night. And that research was culled before the recession was official.

As the economy worsens, those numbers will most likely increase, according to sleep medicine experts. For starters, those at Stanford and the University of California San Francisco report waiting lists of up to two months. While that’s not entirely unusual, they are hearing complaints from existing patients that the economic crisis is an additional stressor and is exacerbating their current sleep problems or causing their insomnia to resurface.

Most patients have an inability to fall asleep or stay asleep, says Christine Won, associate director of the Sleep Disorders Center at UCSF Medical Center. "They complain about a lot of anxiety, mind-racing and an inability to relax and unwind," Won says. "I can only assume that the more our economy is in turmoil, the bigger toll it will take on our sleep." People’s ability to triumph over their recession-induced insomnia depends on how effective their coping mechanisms are and how much control they have over their finances, she adds.

Ironically, research has yet to prove why we need sleep. Some studies suggest a purging of chemicals; that the body somehow resets itself overnight in slumber mode, Won explains. But we know that a lack of sleep results in a lower immunity, cognition and emotional health. And fragmented sleep has been linked to an increased risk of cardiovascular diseases. Prolonged insomnia can also lead to or increase chances of anxiety, depression and other mood disorders.

Here’s a dose of reality: "When you look at rats that are sleep-deprived, they get ulcers, their hair falls out and they die sooner," Dr. Won says.

Point made. When a patient comes to see Dr. Won, the physician first rules out underlying diseases that may contribute to sleep problems. After that, if she determines that the issue is due to acute stress, Won starts the patient on a regimen of good sleep hygiene, which can include everything from avoiding caffeine to hitting the sheets at the same time every night.

She also tries to undo poor sleeping habits. For instance, fragmented sleepers should not look at the clock every time they wake up because, over time, they may be training their bodies to wake up. Also, Dr. Won condones relaxation exercises – yoga, imagery, biofeedback and breathing techniques – an hour before bedtime. All of these lifestyle changes can take up to six weeks to prove effective, but they work for about 70 percent of patients, Won says.

Those who don’t experience relief typically spend a night at the clinic, where their sleep is monitored for evidence of disorders such as sleep apnea or restless leg syndrome. If none is present, Dr. Won diagnoses the person with psychophysiological insomnia and prescribes hypnotics, or sleeping pills. A small number of chronic insomniacs require sleep deprivation therapy, or, what Won calls "boot camp for insomniacs."

"We write out a program restricting their sleep for weeks so they essentially fall asleep from exhaustion," she says. "It works, but it’s not pleasant."

At the Stanford Sleep Clinic in Palo Alto, postdoctoral psychology fellow Allison T. Siebern educates patients about normal sleep and methods of relaxation. Like UCSF, Stanford has seen a rise in sleep concerns among existing patients, Siebern says.

She works in the behavioral sleep medicine division of the psychology department and performs assessments on patients. Usually, the first step is to create a buffer time before bed to do calming or relaxing activities, such as reading or crafts. For other patients, the challenge is teaching them to limit the time that they’re awake in bed. Take note: Do not pay bills in bed or get under the covers with your laptop.

Dr. Siebern also teaches patients mindfulness meditation, muscle scans and progressive muscle relaxation and imagery to help them relax. When necessary, she uses timed light exposure, which resets a person’s sleep-wake body clock. The biggest mistake people make when it comes to sleep? Putting pressure on themselves, Siebern says.

"When it doesn’t happen they become frustrated and it becomes a cycle," she explains. "Sleep is a process that cannot be forced, and the more the patient tries to control sleep the less likely sleep will happen."

Joe Ruby has almost given up on trying to sleep. The Pittsburg, Calif., resident spent much of 2008 recuperating from surgery to remove a tumor from the back of his head. His sleep issues started with his diagnosis back in late 2007. Ever since, he clocks about four hours of fragmented sleep per night. Usually, he falls asleep at 10 p.m., wakes up at 1 a.m. and isn’t sure if he falls back asleep or not. He tosses and turns at night and yawns "like heck" during the days, he says.

"Do I have a lot of things on my mind? My lifeline is tied in stocks and the economy," Ruby says. "Without that I feel I’m going to go under. I have dreams and hallucinations of things going wrong. What am I going to do if the economy worsens? I worked my whole life to have a house so I wouldn’t be bothered by landlords."

Now, it’s all at risk. Ruby tried sleep medication, but the pills made his sleep too heavy, he says. These days, he tries to stay as active as possible during the day. It seems to help him at night. Otherwise, he spends his nights in a haze of sleep, wakefulness and an overactive mind.

"The world is in chaos," he says. "And it affects me."

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