AYURVEDA THERAPY INSTITUTE

UDUPI, KARNATAKA, INDIA

AYURVEDA FOR POSITIVE HEALTH
An Online Study Program

PART II. LESSON 8


NIDRA : SLEEP

The ahara is mainly concerned with the energy production and
maintenance of living tissues. The nidra is the one which provide
complete relaxation to the body and mind and thereby it restores
the potentials of the individual. The brahmacharya (celibacy) is
concerned with disciplined mode of sexual life and reproduction.

According to darsanas, there are four avasthas or states of mind
and atma. They are
v Jaagratavastha
v Svapnavastha
v Sushuptiavastha
v Tureeyavastha

v Jaagradavastha- In this phase, the person is able to perceive
subject via panchendriyas
v Svapnavastha- This is the phase of sleep in which the person
experiences some feelings depending upon what he has done or
perceived during the jaagratavastha.
v Sushuptiavastha- This also is a phase of sleep but nothing is
experienced by the person. Only the life sustaining vital
functions (like respiration, circulation etc) happen.
v Tureeyavastha- This is experienced only by yogis. Due to
aadhikya in satva guna, the person has full control over his
nidra and there is no effect of tamoguna on this phase.

In nidra, both the Svapnavastha and Sushuptiavastha are included.

According to yoga sastra, nidra is that function of mind which
blocks all the perception done by the mind. During nidra the mind
is subjected to the feeling from inside i.e. from the mind itself.

NIDRA-WHEN AND WHY?

Charakacharya explains the nidra as a special state of mind in
which the mind is not associated with any type of indriyas. This
detachment from the external stimuli is resulted from the tiredness
of body as well as mind. Kapha dosha and tamoguna are responsible
for sleep.

According to Susrutacharya, the nidra occurs when the
chetanaasthaanam i.e. hrdaya(heart)is covered by tamoguna.

For vaagbhata, nidra is tamomoola and tamomayi. The night is tamo
adhika, by its nature. This tamo aadhikya contributes to the nidra
as nidra itself is tamomoola and tamomayi. In addition when the
mind becomes tamo adhika and/or body becomes kaphaadhika (which is
the bodily counterpart of tamoguna) indriyas become inactive and
nidra happens.

EFFECTS OF NIDRA
The physiological change during sleep is best manifested in the
heart. The heart or hrdaya is compared with a lotus flower which
blooms in the day time and withers in the night time. Similarly the
hrdaya droops when the person sleeps. The body achieves the proper
relaxation and rest through the sleep. Thus nidra is as important
as nutritious food for the maintenance of health.

Charakacharya opines that the sukha & duhkha, pushti & kaarsya,
bala & abala, vrshata & kleebata, jnana & ajnana and the very
presence and absence of life depend on the management of sleep
pattern. A well modulated sleep pattern surely brings delight and
longevity to the person.

Susrutacharya also has similar opinion. He says that the nidra
brings bala, varna, vrshyata to the person and the body of such
persons may be well built but not obese. The lifespan of such a
person may extend up to hundred years.

Bhaavamisra opines that the nidra in the proper time provide
dhatusaamya, absence of tandra, pushti, varna, bala and utsaaha. In
addition it also causes agnideepti.

THE DURATION AND TIME OF NIDRA
Susrutacharya says that the person should sleep for a moderate time
period only. This is so relevant because the nidra at an improper
time and duration cannot produce any desirable effect but the
effect of such nidra may be like the effect of kaala raatri.

Hence the effect of nidra strictly depends on the proper timing.

Why such restriction in the time and duration of nidra has been
suggested by acharyas? It is because the deprivation of sleep
during night and sleeping in the day time are equally disagreeable
to health for, they alter the equilibrium of
dosha of body considerably.

Still Susrutacharya advocates that one should follow the timing of
sleep, to which he is accustomed, without any difference. If it is
saatmya, the nidra at any time wont alter the doshavastha.
TYPES OF NIDRA
According to Charakacharya as well as Vaagbhatacharya, there are 7
types of nidra. But Susrutacharya opines that there are 6 types of
nidra.


7 types of nidra

v Taamasa nidra: the nidra due to the increased tamo guna of the
manas
v Kaphaja nidra: the nidra due to the increased kapha dosha in
the body
v Manah sramabhava nidra: the nidra due to the exhaustion of
manas or mind
v Sareera sramabhava nidra: the nidra due to the exhaustion of
sareera or body
v Aagantukee nidra: the nidra which forecasts death
v Vyaadhyanuvartinee nidra: the nidra which occurs due to some
diseases
v Praakrtika nidra: the natural form of nidra which happens in
nights.

Among these 7 types of nidra the paakrtika nidra is the only
desirable one. It is also called bhootdhaatri as it fosters the
living things as their mother. The Taamasa nidra is the worst as it
is the root cause of each and every sin. The remaining 5 reveal the
unhealthy state only and they should be regarded as diseases.


6 types of nidra
v Vaishnavi: it is the one which is included under the
upastambha
v group. As it is so helpful to the maintenance of the healthy
state of an individual (just like the lord Vishnu maintain the
harmony of universe) it is called vaishnavi.
v Taamasi: it is the form nidra which occurs due to excess tamas
or kapha in the sanjnaavahasrotas.
v Nidra in tamoguna persons: here the nidra comes irrespective
of day and night.
v Nidra in rajo guna persons: here the nidra can come at any
time irrespective of day and night. But this may not happen
always.
v Nidra in satva guna persons: here the sleep comes only in
midnight
v Vaikaariki: it is the form of nidra resulted from some
disease.




SIMILAR CONDITIONS LIKE NIDRA
As per Susrutacharya, tandra is similar state like nidra but with
increased gaurava, jrmbha and klama. Nidra like conditions can be
produced by abnormality of indriyas as well as increased tamas.
Saarngadharacharya opines that nidra is produced by the action of
tamas and kapha while moorchha is produced by tamas and pitta.
Bhranti happens due to the influence of rajas and pitta and tandra
is produced by tamas and vaayu.

Hence the conditions similar to nidra can be counted as follows:
1. Tandraa- is a condition characterised by reduced acuity of
perception, yawning and tiredness. This condition is similar to
intense urge for sleep. This may be correlated with stupor. This is
caused by the increase of tamas,vaata and kapha.

2. Jrmbhaa- yawning

3. Klama- usually fatigue occurs after physical labour. A condition
of tiredness without prior physical exertion is called klama. It
may be roughly correlated with exhaustion.

4. Aalasyam- Laziness. It is the lack of interest to work.
Technically it is the aptitude for rest and the aversion for work
even when the person is having sufficient physical strength for
doing work.

5. Glaani- is a state characterised by abnormal sweet taste in
mouth, stupor, nausea, giddiness and anorexia

6. Gauravam- feeling of heaviness, as though wrapped in wet
leather.

7. Moorcchaa- fainting caused by the increase of pitta and tamas.

8. Bhramaa- giddiness due to the increase of rajas, pitta and
vaata.


SAYANA VIDHI
The Vaagbhatacharya suggests that a person can go to bed for sleep
after taking light but healthy supper. He should avoid all the
distressing thoughts and thus clean the mind. Just before sleeping
one should think about the almighty God. He can use a pillow which
is comfortable for him. The bed should be covered with clean bed
linen and it should be wide and even and should be comfortable for
the person.

The sayanavidhi formulated by Bhaavamisra also convey the idea
about the qualities and effect of different sayya or bed as well
as the place to sleep. He opines that sleeping on bed with good
qualities is hrdya and vrshya. It removes the tiredness of body and
mind and provides pushti, dhrti and sound sleep. Sleeping on cot is
tridoshasamana. Sleeping on bed which is filled with feather is
kapha vaatahara. Sleeping on floor provides brmhana and vrshyata
and reduces the pitta and rakta doshas. Sleeping on plank is
vatala.
Sleeping in the moonlight is seeta and provides smraananda. It
reduces trshna, daaha and pitta. Compared to this, sleeping in the
avasyaya is of less qualities because it may cause vaata kaphakopa.
Sleeping in complete darkness may frighten the individual because
when gets up from sleep suddenly one can not identify the place and
direction due to extreme darkness. But it is pitta kapha Samana and
kaamavardhana. It creates klama.


UNHEALTHY NIDRA HABITS
There are two types of sleep habits which are described as totally
unhealthy in nature. They are divaasvapna and raatrijaagarana

Divaasvapana
Night is the accepted time for nidra and sleeping in the day time
is contra indicated as it may produce sleshma pitta kopa.

There are some special occasions in which sleeping in day time is
indicated. They can be categorized as follows:
v In relation with rtu
v In relation with diseases
v In relation with activities
v In special category individuals


In relation with rtu:

Divaasvapna is indicated in greeshma rtu to all the
individuals. This is because, o Greeshma rtu comes under aadana
kaala which characterised by rookshana svabhaava. This causes vaata
vrddhi. Inorder to reduce this effect divaasvapna can be performed.
o The duration of night is much reduced in greeshma rtu. In order
to get the required sleep, one can sleep in the day time also.

In relation with diseases:

That there are some diseases in which, divaasvapna is
indicated to reduce the tiredness and other ill effects caused by
these diseases. They include
o Trshna
o Soola
o Hikka
o Jeernaatisaara
o Svaasa
o Ajeerna
o Kshata
In relation with activities:

Divaasvapna can be performed following the activities like,
o Singing
o Long lecture
o Consumption of alcohol
o Sexual intercourse
o Sodhana therapy
o Weight lifting
o Walking long distances
o Traveling in vehicles
o Deprivation of sleep in night
o Emotional outbursts

Divaasvapna just before the intake of food is favorable as it
improves the digestive capacity.

In special category individuals:
o Vrddha (old people)
o Baala (children)
o Abala (weak people)
o Krsa (lean people)
o Those who are accustomed to the divaasvapna

Here, the divaasvapna brings about dhaatusaamya, bala,
sleshmavrddhi, sthairya or stability of body parts and life.



DIVAASVAPNA CONTRA INDICATIONS.

Divaasvapna is generally contra indicated in all rtus except
greeshma as it may cause sleshma pitta kopa. In addition, in the
following categories also, the divaasvapna is strictly contra
indicated
o Obese individuals
o Those who take fatty substances daily
o Kapha prakrti individuals
o Those who suffer from kapharogas
o Those who suffer from doosheevisha

Yoga ratnaakarakaara opines that the sleeping after the intake of
food is so unhealthy that it causes kopana of all the three doshas.

The adverse effects of divaasvapna in totally contra indicated
conditions:

The performance of divaasvapna in totally contraindicated
conditions may produce certain complications like haleemaka,
sirassoola, staimitya, gaatragaurava, angamarda, agni maandya,
hrllepa, sotha, arochaka, hrllasa, peenasa, arddhavabhedaka, kotha,
arumshika, pitaka, kandu, tandra, kaasa, galaroga, smrtibhramsa,
buddhibhramsa, srotorodha, jvara, lack of ability of indriyas,
vishavegapravartana in vishaartas.
But sleeping in sitting posture is neither abhishyandi nor
rookshana.

Raatrijaagaranam
As stated elsewhere the night is the suitable time for sleep and it
should be used for sleeping. The deprivation of sleep in night time
is extremely rookshana and it causes vaatapitta vrddhi. But
raatrijaagaranam is indicated in those who suffer from kapha or
medas or visha.

Nidra- one of the vegaas
Vegas are the natural urges which should not be controlled
deliberately. Nidra is one among the 13 vegas. The dhaarana of
nidraavega may cause moha,gaurava of sirah and akshi, aalasya,
jrmbha and angamarda. The treatment that can be given to these
symptoms is nothing but to allow the individual to sleep. Gentle
touch also can promote sleep.

Nidraanaasa
Nidraa naasa is nothing but the inability to sleep in night. This
may be caused by vaatadosha or pittadosha or due to manastaapa,
sosha or abhighata.

The causes of nidraanaasa can be tabulated as follows:
Treatment processes Virechana, nasya, vamana,
dhoomapaana, raktamokshana,
atiyoga of atinidraa treatment
Feelings Bhaya, chintaa, krodha

Condition of manas Increased satva, reduced tamas

External conditions Vyaayaama, upavaasa, asukhasayyaa

Other factors Kaarya, kaala, vikaara, prakrti,
vaatavrddhi


Nidraanaasa may cause angamarda, sirogurutva, jrmbha, jaadya,
glaani, bhrama, apakti, tandraa and other rogas caused by vaata
dosha.


TREATMENT FOR NIDRAANAASA:

There are some effective guidelines to get sound sleeps. They
include, the usage of the following processes and products like
abhyanga (external application of oil), utsaadanam, snaana, intake
of graamya, anoopa or audaka variety of meat, saaliannam, milk ,
curd, fatty food items, alcoholic beverages, relaxed mind, pleasant
smell, pleasing sound, gentle touch, akshi tarpana, sirolepa,
vadanalepa, goodbed bedlinen, appropriate time for sleep etc.


Atinidraa
Atinidraa is caused by increased kapha in the srotas which may lead
to gaatra gaurava. Gaatra gaurava causes aalasya which in turn
results in nidra. This is not at all favourable for the body as
well as mind.
Prognosis of atinidraa

Atinidraa if not exceeded 1 days, is saadhya and beyond that it
is asaadhya.

Ayurvedic glossary of nidra (sleep)
Aalasya - laziness
Alpanidrataa - reduced sleep
Anidrataa - insomnia
Asvapnah - sleeplessness
Atisvapnah - excessive sleep
Bahusvapnah - excessive sleep
Jaagaranam - keeping awake
Jrmbhaa - yawning
Klama - exhaustion
Mada - intoxication
Mahaasvapnah - excessive sleep
Moorcchaa - fainting
Nidra - sleep
Nidraabhaava - insomnia
Nidraabhramsa - interrupted sleep
Nidraahaani - lack of sleep
Nidraanaasa - insomnia
Nidraaviparyaya - day sleep and night awakening
Nistandrataa - lack of tiredness in spite of not sleeping
Prajaaagaranam - keeping awake
Sayana - 1) sleep 2) lying down
Svapna - 1) sleep 2) dream
Svapnanityataa - excessive sleep
Sannyaasa - coma
Tandraa - stupor
Unnidrataa - inability to sleep
Vinidrataa - insomnia


SLEEP-the modern aspect of nidra
Sleep is a physiological phase of unawakening that exists between
two phases of normal and routine awakening. It is a period of rest
for the body and mind during which bodily functions are partially
suspended and sensitivity to the external stimuli is diminished,
but readily or easily regained.

Clinical features of sleep:
Usually a person sleeps about 8 hours in a 24 hours period. During
sleep
v The person appears to be cut off from the environment
v The threshold for various sensory stimulations are
substantially raised
v Muscle tones fall and muscle relax
v Blood pressure, heart rate and rectal temperature fall,
respirations become slower but deeper.

Some persons snore due to the fact that relaxed tongue in supine
posture partly obstructs the air passage.

Sleep rhythm
Animals and humans show one sleep period in 24 hours. Night,
commonly being the period of rest is used for sleep. But this
considerably varies with habit. (In night shift workers, day
sleeping is the habit.) A term sleep wake cycle is frequently
used. In a 24 hour period, a man, sleeps about 7 hours and remains
awake for the 17 hours. So the sleep wake cycle of the given person
id 7/17 hours. Sleep wake cycle of a given person is reasonably
fixed. If for any reason a person has to sleep less for one or two
days, he compensates the lost hours of sleep by oversleeping in the
following days. This is an example for the working of biological
clock and this rhythm of sleep is often termed as circadian rhythm.

Sleep requirements
During sleep the body gets repaired by itself and the brain
processes the days events and help to sort them. Some sleep more
and others sleep less, but both may be normal. The range of
deviation of sleeping hours in the normal adult population is 4 to
10 hours per day, although the infants and children sleep more
while the old people sleep less. A normal adult can withstand
several days (up to 10 days) of sleep deprivation without showing
any remarkably gross changes.
Category Sleep requirement

New born babies 16- 20 hours

Children 12-14 hours

Adults 4-10 hours

Old age About 5 hours



Infants sleep for pretty shorter periods at a stretch. In a new
born infant the duration of each sleep is only up to 60 minutes.
Sleep alternates with states of wakefulness. The state of
wakefulness is also about one hour. When the infant is one year
old, the length of periods of sleep and wakefulness becomes
longer and extend up to 90 minutes. Later, day time sleep becomes
lighter and the child gets longer sleep at night. As the child
grows older, he may require only one or two day time naps.

The sleep cycle
An individual sleep cycle lasts for about 1 hours. Thus assuming
a subject sleeps for about 8 hours in a night there will be some
five such sleep cycles in the whole period. Each cycle of the sleep
contains various stages of sleep.

Stages of sleep
Normal sleep consists of two types: - non rapid eye movement sleep
(NREM sleep) or slow wave sleep and rapid eye movement sleep (REM
sleep). Because of the fact that eyeballs move and yet the sleep is
deeper, the REM sleep is also called paradoxical sleep The
physiological characteristics of these phases are largely opposite.
Both the phases have a complex multilevel structure that ensures
the development of active brain processes characteristic of
each phase. In NREM sleep, tonic or stable changes in vegetative
and motor indices occur. The muscular tension decreases,
respiratory rate and cardiac rhythm become slow. In REM sleep, the
EEG records rapid low amplitude oscillations, similar to those in
the initial stage of sleep or even wakefulness. Physical changes
are also noted. Rapid eye movements, twitching of facial
muscles and extremities, disturbed breathing, changes in heart rate
and hypertension are seen in REM sleep.

The NREM or slow wave sleep consists of four stages, each of which
gradually merges into the next. Each stage has been identified by
EEG recordings.

v Stage 1- This is a transition stage between wakefulness and
sleep that normally lasts from 1 to 7 minutes. The person is
relaxing with eyes closed and has fleeting thoughts. If
awakened, the person will often say he has not been sleeping.
Alpha waves diminish and theta waves appear on the EEG.

v Stage 2- This is the first stage of true sleep, even though
the person experiences only light sleep. It is a little harder
to awaken the person. Fragments of dreams may be experienced,
and the eyes may slowly roll from side to side. The EEG shows
sleep spindles- sudden, short bursts of sharply pointed waves
that occur at 12 to 14 Hz.

v Stage 3- This is a period of moderately deep sleep. The person
is very relaxed. Body temperature begins to fall and blood
pressure decreases. It is difficult to awaken the person, and
the EEG shows a mixture of sleep spindles and delta waves.
This stage occurs about 20 minutes after falling asleep.

v Stage 4- Deep sleep occurs. The person is very relaxed and
responds slowly if awakened. When bed wetting and sleep
walking occur, they do so during this stage. The EEG is
dominated by delta waves.

In a typical 7 or 8 hours sleep period, a person goes from stage 1
to 4 of NREM sleep. Then the person ascends to stage 3 and 2 and
then to REM sleep within 50 to 90 minutes. The cycle normally
repeats throughout the sleep period.

In REM sleep the EEG readings are similar to those of stage 1
of NREM sleep. It is during this sleep that most of the dreaming
occurs. The eyeballs move frequently, the muscles relax more and
the intensity of sleep is more. The eye ball movements are probably
due to the fact that the subject follows the objects in the dream.
Yet because of greater muscle relaxation, the subject is unable to
move. May be because of this, the subject feels a sense of
paralysis, even though the situation in the dream demands physical
movements. In men, erection of the penis happens during most REM
intervals, even when the dream content is not sensual. Following
REM sleep, the person descends again to stage 3 and 4 of NREM
sleep. Towards morning the REM sleep becomes longer and NREM sleep
becomes shorter. The REM periods start out lasting from 5
to 10 minutes and gradually lengthen until the final one lasts
about 50 minutes. Most sedatives significantly reduce REM sleep.

If people are awakened during REM sleep they almost always say
they have been dreaming and they are able to recall their dreams in
vivid details. When people are awakened during stage 2 through
stage 4 they rarely claim to have been dreaming and they never
remember many details. However, strong panic emotions with little
dream imagery occur in stage 3 and 4. These emotions are called
night terrors or sleep terrors. They consist of labored breathing
and paralysis and high anxiety.

As a person ages, the average time spent sleeping decreases.
In addition, the percentage of REM sleep decreases. As much as 50%
of an infants sleep is REM as contrasted with 35% for 2 year olds
and 25% for adults. The high percentage of REM sleep in infants and
children is thought to be important for the maturation of the
brain. Neuronal activity is high during REM sleep; brain oxygen use
is higher during REM sleep than during intense mental or physical
activity while awake.

The sleep pattern of an individual changes significantly after
a long period of sleep deprivation. Scientists observed that the
individual, after a period of sleep deprivation of 264 hours, spent
much more time in stage 4 on the first recovery night, at the
expense of stage 2. On the second recovery night, REM sleep
increased sharply at the expense of stage 2 through 4. The
phenomenon of increased REM sleep after sleep deprivation is called
REM rebound.
The effects of sleep deprivation suggest that sleep repairs
and restores various systems. Prolonged deprivation leads to
irritability, fatigue, poor concentration, memory failure and
reduced muscle co ordination. Some people are associated with
behavioral abnormalities and mental illness.

When the people are allowed to sleep except when they enter
stage 4 and REM sleep, they develop the same symptoms as if they
had been deprived of all their sleep. Such experiments indicate
that we need sleep especially stage 4 and REM to maintain normal
functions. Selective deprivation of REM sleep alone suggests that
it is especially important in solidifying memories from skills
learned the day before. The skills are remembered less well by REM
deprived people than they are by people who sleep normally or by
people who are deprived of other stages of sleep.

Physiological changes during sleep
During sleep, somatic activity is greatly decreased. Threshold
of many reflexes is elevated and responsiveness is also lessened.
Man cannot remember the events occurring during sleep.
The metabolic rate being the least, all tissues and organs
perform the least work. The physiological changes can be tabulated
as follows:

Systems/somatic functions Changes during sleep

Circulatory system Pulse rate, cardiac output,
vasomotor tone and blood pressure
reduced


Respiratory system a) Respiration may be costal or
periodic, especially in children
b) Tidal volume, rate of
respiration
and, therefore, pulmonary
ventilation-lowered. (Sometimes
the rate may be unchanged or
even high due to shallow
breathing.

Metabolic rate Reduced by 10-15%

Secretions a) Salivary and lachrymal reduced
b) Gastric- unaltered or raised
c) Sweat- raised
d) hGH of pituitary- increased

Urine Volume reduced, reaction may be
variable, specific gravity and
phosphates- raised
Muscles Relaxed and the tone is minimum

Eyes a) Eye balls- roll up and out due
to
flaccid external ocular muscles
may take up any position
b) Eye lids- come closer,
specially
due to drooping of upper eyelid
c) Pupils- contracted

Blood Volume is increased due to
dilution of
plasma

Nervous system a) Deep reflexes reduced
b) Babinski- extensor
c) Superficial reflexes unchanged
d) Vasomotor reflexes- more brisk
e) Light reflex- retained



Factors affecting sleep:
1. Food: It is known to affect the pattern of sleep. Heavy late
meals usually cause night mares. When digestion is disturbed it
will reflect on the sleep and alarming dreams may occur. Coffee and
tea may prolong the time taken for falling asleep as they contain
caffeine.

2. Drugs: Drugs also change the pattern of sleep. Diet-pills
contain stimulants and hence reduce sleep. Tranquilizers and
hypnotic drugs induce and prolong sleep. Sleep induced by sleeping
pills is mostly blank and dreamless.

3. Addictions: Alcohol and cigarettes affect both NREM and REM
sleep. They speed up the fluctuation between these two phases of
sleep. When the effect of alcohol is over, the person falls into
REM sleep and that reduces possibility of deep relaxation.

4. Stimuli: External stimuli such as light and sound usually
disrupt sleep. Some people find it very difficult to get sleep when
the lights are on. Usually slow music in low volume is conducive to
sleep but loud noises interrupt sleep. Touch also has an influence
on sleep. A soft and comfortable bed promotes sleep. Rough and hard
touches hinder sleep.
5. Physical/mental work: A person exhausted by physical exercises
may fall asleep quickly. Serious thinking will ward off sleep.
Hence it is not advisable to contemplate on serious topics at
bedtime. But monotonous mental activities such as repeated counting
usually invite sleep.

Sleep disorders:
The sleep related disorders can be classified as follows:
Insomnia
Hypersomnia
Sleep-wake schedule disorders
Parasomnia

Insomnia:
The term insomnia is used to describe a condition when there is
inability to fall asleep or stay in sleep or there is reduction
total time of sleep. Insomnia may be secondary, due to causes like
acute hostile environment, exciting situations continuing for many
days, or due to severe pain or due to some mental diseases. In most
cases, there is no apparent cause and such cases may be called
primary insomnia.

Hypersomnia:
Hypersomnia refers to an excessively long or deep sleep from which
a person can be awakened only by vigorous stimulation. It may be
associated with conditions such as with head injury, stroke, and
encephalitis. The conditions which can be included under this
heading are narcolepsy, idiopathic hypersomnolence, sleep apnoea,
the Kleine-Levin syndrome.

Narcolepsy: This is a condition of involuntary attacks of sleep
that last about 15 minutes and may occur at almost any time of the
day. It is an inability, in waking state, to inhibit REM sleep.
This condition is more common in males. There may be a family
history of narcolepsy. It may be a genetically transmitted disorder
as an autosomal dominant trait. Patients with narcolepsy often have
secondary emotional and social difficulties, and their difficulties
are increased by other peoples lack of understanding. Many
etiological theories have been advanced but none is convincing.

Idiopathic hypersomnolence: This is the most prevalent of primary
hypersomnias. Patients complain that they are unable to wake
completely until several hours after getting up. During this time
they feel confused and may be disoriented. They usually have
prolonged and deep night-time sleep. Almost half of them have
periods of day time automatic behavior, the etiology of which
is obscure.

Sleep apnoea: This syndrome consists of daytime drowsiness together
with periodic respiration and excessive snoring at night. It is
usually associated with upper airway obstruction.

The Kleine-Levin syndrome: This consists of episodes of somnolence
and increased appetite, often lasting for days or weeks and with
long intervals of normality between them. Patients can always be
roused from the daytime sleep, but are irritable on waking and
occasionally aggressive, some are muddled and experience
depression, hallucinations and disorientation.

Sleep-wake schedule disorder:
Fatigue and transient difficulties in sleeping accompany changes in
bodily rhythms after travel across time zones or changes in shift
worm. Regular changes of shift or the irregular alternation of
night work and days off may lead to chronic problems of poor sleep,
fatigue, impaired concentration and an increased liability to
accidents.

Parasomnias:
The conditions which can be included under this heading are
nightmares and somnambulism.

Nightmares: This is also called dream anxiety disorder. A night
mare is an awakening from REM sleep to full consciousness with
detailed dream recall. Night mares may be stimulated by frightening
experiences during the day, and frequent night mares usually occur
during a period of anxiety.

Somnambulism: This is also called sleep-walking. This is an
automatism occurring during deep non REM sleep, usually in the
early part of the night. It is most common between the ages of 5
and 12 years. Most of them do not actually walk, but sit up and
make repetitive movements, Some walk around, usually with their
eyes open, and in a mechanical manner but avoiding familiar
objects. They do not respond to questions and are very difficult to
wake. They can usually be led back to bed. Most episodes last a few
seconds or minutes, but rarely as long as an hour.

Conclusion:
The concept of nidra and sleep are quite comparable. The nidra is
so important for the maintenance of health. This is true in the
light of modern scientific knowledge also. According to ayurvedic
concept, the kapha and tamas are responsible for the nidra; while
the sleep production has been attributed to many factors including
stimulation of certain areas of brain.

Ayurveda classifies the nidra on the basis of the mode of origin
while modern classification of sleep is based on physiological
variations seen in association with the different types of sleep.
Nidra or sleep is affected by a number of factors like food,
activities, external stimuli etc. Any variation in the normal sleep
pattern is not at all desirable and they may cause serious health
problems which demand proper medical attention.
*****