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Insomnia describes when someone’s experience of sleep is not sufficient to leave them rested and refreshed.

Insomnia: An Ayurvedic perspective

"Dependent on sleep are happiness and misery, corpulence and leanness, strength and weakness, potency and impotency, intellect and non-intellect, life and death.” - Charaka Samhita Sutrasthana

Understanding insomnia

The Caraka Samhita (CS) is an early text on Ayurveda (Indian traditional medicine). It is one of the two foundational texts of Ayurveda dating back to the period of 900 BCE – 600 BCE.

Insomnia An Ayurvedic perspective

Insomnia and depression are disorders that often go together. Up to 20% of people with insomnia disorder also fulfil criteria for major depression and for people with depression, 69% also report mild or moderate insomnia. Longitudinal studies have showed that insomnia is a well-established risk factor for developing depression and that more severe insomnia is associated with more severe depression. Together, these results indicate that it is important to treat sleep problems as they mark a higher risk for future depressive episodes.

Insomnia can exacerbate any other illness or be caused by many illnesses. Either way it can acutely degrade the quality of life leading to chronic tiredness, stress and under performance.

Allopathic management of insomnia

Several different types of medications are used for treating insomnia. However, many doctors do not recommend relying on prescription sleeping pills for long-term use. Modern management of sleep disorders depends on the cause of the insomnia and may involve hypnotics, analgesics, anti-depressants and anti-histamines.

Certain classes of sedatives can also cause physical dependence, which manifests in withdrawal symptoms if the drug is not carefully tapered down. Hypnotic medications also can have a number of side-effects such as daytime fatigue, motor vehicle crashes, cognitive impairments, falls and fractures. Elderly people are more sensitive to these side-effects.

Benzodiazepines: These drugs promote the action of the neurotransmitter gamma-aminobutyric acid (GABA) which binds to neurons and slows the transmission of electrical impulses between brain cells. This slows communication of thoughts, causes drowsiness and induces a drug-induced sleep. These drugs are normally recommended to be used only for transient and short-term insomnia, although in many cases end up being used on a long-term basis. Many of these drugs interfere with the normal sleep cycle, inhibiting both REM (Rapid Eye Movement) and NREM (Non-REM) sleep, and thus interfere with the restorative benefits of sleep. If they are used over a longer period of time they can lead to psychological and physical dependence. Sudden withdrawal leads to rebound effects of anxiety, insomnia and restlessness. Hypnotic benzodiazepines include drugs such as temazepam, clonazepam, lorazepam, oxazepam, diazepam etc.

Nonbenzodiazepines: are a class of psychoactive drugs that are very benzodiazepine-like in nature. Their pharmacodynamics are almost entirely the same as benzodiazepine drugs and therefore employ similar efficacy with similar side-effects, and risks. The non-benzodiazepines zolpidem and zaleplon have not adequately demonstrated effectiveness in sleep maintenance.

Barbiturates: Can cause heavy sedation and rarely used in clinic due to the tendency to cause dependency. Barbiturates have now largely been replaced by benzodiazepines in routine medical practice – in the treatment of anxiety and insomnia, because there is no specific antidote for barbiturate overdose. Barbiturates include Seconal and Medaral.

Anti-histamines: Predominantly used to treat allergies. As an alternative to taking prescription drugs, some evidence shows that an average person seeking short-term help may find relief from taking antihistamines such as diphenhydramine or doxylamine. However, the anti-histamines that enter the brain can also cause drowsiness and the agents may decrease over time, whilst the incidence of next-day sedation is very high leading to a drowsy day ahead. This can perpetuate a poor sleep cycle as people will use caffeine to stay awake which can lead to insomnia in the evening.

Anti-depressants: Selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) are increasing levels of a group of chemicals in the brain called neurotransmitters like serotonin and noradrenaline which can improve mood and emotion. While antidepressants can help treat the symptoms of depression, they do not address its causes. Fluoxetine is probably the best known SSRI (sold under the brand name Prozac). Other are citalopram (Cipramil), paroxetine (Seroxat) and sertraline (Lustral).Examples of SNRIs include duloxetine (Cymbalta and Yentreve) and venlafaxine (Efexor). However, in some cases insomnia is experienced as one of its side effects.

Tricyclic antidepressants (TCAs) are an older type of antidepressant showing more unpleasant side effects than SSRIs and SNRIs. Examples of TCAs include amitriptyline (Tryptizol) – can have a sedative effect, and are prescribed to treat insomnia; clomipramine (Anafranil), imipramine (Tofranil), lofepramine (Gamanil) and nortriptyline (Allegron).

As with benzodiazepines, the use of antidepressants in the treatment of insomnia can lead to withdrawal effects.

Many herbs are suitable for self-care. However if a health condition does not resolve with home remedies we recommend using the information in Herbal Reality along with your health advisors, especially herbal practitioners from the professional associations listed in our Resources page (‘If you want to find a herbalist”). When buying any herbal products, you should choose responsible manufacturers with independently assured quality standards and sustainability practices. Check the label carefully for the appropriate safety and sustainability information.

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