INSOMNIA

• Insomnia is also known as the Disorder of Initiation and/or maintenance of sleep
• Individuals with insomnia find it difficult to fall asleep or stay asleep. As a result, the person may get too little sleep or have poor-quality sleep, and may not feel refreshed on waking up
• Insomnia is a common symptom of other mental disorders such as affective, neurotic, organic, schizophrenia etc.
• Prolonged sleeplessness is often associated with substantial distress, impairment in day time functioning or both
• Reduction in perceived health and quality of life, increase in workplace injuries and absenteeism and even fatal injuries are all associated with chronic insomnia
• It is very common, with nearly 15-30% of the population complaining of a period of insomnia per year requiring treatment

Medical Illnesses :

• Respiratory disease
• Heart diseases
• Brain stem or Hypothalamic lesions
• Delirium

Alcohol & Drug abuse :

• Delirium Tremens
• Amphetamine or other stimulants
• Withdrawal syndrome

Medications :

• Steroids
• Theophylline
• Propranolol

Psychiatric Disorders

• Mania
• Major Depression
• Dysthymia
• Anxiety disorder

• Difficulty in initiating sleep (going off to sleep)
• Difficulty in maintaining sleep (remaining asleep) This can include both Frequent awakenings during the night and early morning awakening
• Poor quality of sleep
• Non-restorative sleep: feeling fatigued after waking 

Differential Diagnosis

• Depression
• Obstructive Sleep Apnoea
• Periodic limb movement Disorder
• Restless leg syndrome

• Clinical diagnosis is as per the ICD11 or DSM 5 criteria
• MRI brain to exclude organic causes
• Symptoms occur ≥ 3 days/week for ≥ 3 months

Behavioural therapy

• Sleep Hygiene
• Stimulus control therapy
• Cognitive behavioural Therapy

Internal Medicines:

• Drakshadi kashaya –reduce the associated stress and over concern
• Samana snehapana - Mahapaisachika ghrita
• Somalatha churna
• Aswagandha churna + Jadamamsi churna in equal quantity

Procedures:

• Nasya with ksheerabala 101
• Siroabhyanga with chandanadi taila / himasagara taila / ksheerabala taila
• Siro pichu
• Talam with Kachooradi choorna + Ksheerabala taila
• Sirolepa
• Takradhara/ kashaya dhara