E-ISSN:2456-3110

Research Article

Nidranasha

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 5 June
Publisherwww.maharshicharaka.in

A clinical study on combined effect of Padabhyanga and Pranayama in Nidranasha (Primary Insomnia) - Research Article

Hiremath A.1*, Yalagachin G.2, Resmi K.3, Uday T.4, Chaithra H.5, Ashitha N.6
DOI: http://dx.doi.org/10.21760/jaims.7.5.1

1* Akshay B Hiremath, Final Year Post Graduate Scholar, Dept of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Gurubasavaraj Yalagachin, Assistant Professor, Dept of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 K K Resmi, Final Year Post Graduate Scholar, Dept of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

4 T S Uday, Final Year Post Graduate Scholar, Dept of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

5 H N Chaithra, Final Year Post Graduate Scholar, Dept of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

6 N K Ashitha, Final Year Post Graduate Scholar, Dept of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Sleep is one of the most significant human behaviour, occupying roughly one third of human life. It is the state of mind during which it blocks all the perception from the external world. Qualitative sleep is the essential component of good health. Disturbed sleep leads to discomfort and diseases, can be identified as longer time taken to fall asleep, more periods of wakefulness during the night, and time spent lying awake before rising in the morning. The reported prevalence of insomnia is 33% in the general population globally, and 16% in India and 18.6% in South India. Padabhyanga as a part of Dinacharya is said to induce sound sleep and Pranayama not only enhances Pranashakti but also calms down the stress on body and mind. Hence, in the current study, the combined effect of Padabhyanga and Pranayama practice among elderly population is attempted as remedial measures.

Keywords: Padabhyanga, Pranayama, Nidranasha, Primary Insomnia, Ayurveda

Corresponding Author How to Cite this Article To Browse
Akshay B Hiremath, Final Year Post Graduate Scholar, Dept of Swasthavritta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Akshay B Hiremath, Gurubasavaraj Yalagachin, K K Resmi, T S Uday, H N Chaithra, N K Ashitha, A clinical study on combined effect of Padabhyanga and Pranayama in Nidranasha (Primary Insomnia) - Research Article. J Ayu Int Med Sci. 2022;7(5):1-5.
Available From
https://jaims.in/jaims/article/view/1815

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-05-02 2022-05-03 2022-05-10 2022-05-17 2022-05-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by Akshay B Hiremath, Gurubasavaraj Yalagachin, K K Resmi, T S Uday, H N Chaithra, N K Ashithaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(5)1
Hiremath A et al: Combined effect of Padabhyanga and Pranayama in Nidranasha

Introduction

Sleep is one of the most significant human behaviour, occupying roughly one third of human life. It is the state of mind during which it blocks all the perception from the external world. Qualitative sleep is the essential component of good health. Disturbed sleep leads to discomfort and diseases, can be identified as longer time taken to fall asleep, more periods of wakefulness during the night, and time spent lying awake before rising in the morning. The reported prevalence of insomnia is 33% in the general population globally,[1] and 16% in India and 18.6% in South India.[2]

Most commonly recommended tranquilisers and sedatives for the treatment of insomnia are associated with plethora of adverse effects such as confusion, psychomotor performance deficits, nocturnal falls, dysphoric mood, impaired intellectual functioning, muscle weakness and even coma.

Nidra being called as Adharaneeya Vega is also emphasized as sub pillar of human life as per Ayurveda perview.[3] It is the special state of mind in which absolute detachment of all Indriyas from Bahya Vishayas due to tiredness in body and mind.[4] Padabhyanga as a part of Dinacharya is said to induce sound sleep and Pranayama not only enhances Pranashakti but also calms down the stress on body and mind. Hence, in the current study, the combined effect of Padabhyanga and Pranayama practice among elderly population is attempted as remedial measures.

Methodology

The present study was planned as Out Patient and in-patient, open label, single arm clinical study on combined effect of Padabhyanga and Pranayama in Nidranasha (primary insomnia) using the convenience (non-random) sampling technique at Sri Dharmasthala Manjunatheshwara College and Hospital, Hassan, after approval by Institutional Ethics Committee prior to the starting of the work.

The subjects aged group between 20 to 50 years having sleep disturbance occurs at least three times per week for at least one month with Insomnia severity index[5] above 8 as per WHO approved Insomnia Severity Index were included in this study irrespective of gender, socio-economic status.

Study type: Interventional, open label single arm.

Sampling method: Convenient (non-random) sampling technique.

Sample size: 30.

Duration: 18 months

15-20 ml of Tila Taila (having FSSAI approval) of 40° centigrade is used for Padabhyanga at bed time for a time period of 15 minutes with Brisk shaking movements & Flexion and extension of toes & Thumb poking techniques.

The following Pranayama practice module was taught and advised to be practiced once daily for 30 days.

Table 1: Pranayama practice protocol

SN Type of Pranayama Count Duration
1. A, U, M, OM Chants 3 counts each 10 minutes
2. Anuloma Vilomana Pranayama 10 counts each  5 minutes
3. Nadishodana Pranayama 10 counts*1 round 10 minutes
4. Sheetali 10 counts*1 round 5 minutes
5. Sheetkari 10 counts*1 round 5 minutes
6. Bhramari 10 counts*1 round 5 minutes
7. Shavasana - 5 minutes
8. Shantimantra - 2 minutes

Observations and Results

Table 2: Result on Subjective parameters

Parameters N 0th Day 15thDay 30th Day Cochran’s Q Df Asymp.sig
Difficulty in sleep initiation 30 23 22 7 30.125 2 P<0.005
Difficulty in staying asleep 30 20 14 7 19.538 2 P<0.0005
Gets up in the middle of night and unable to fall asleep 30 23 13 6 25.765 2 P<0.05
Early morning awakening 30 15 12 5 15.800 2 P<0.05
On Angamarda 30 15 15 9 12.000 2 0.002
On Apakthi 30 7 4 2 7.600 2 0.022
On Shirogourava 30 26 19 5 32.667 2 P<0.05
On Jrumbha 30 18 12 6 18.000 2 P<0.05
On Jadyata 30 7 4 1 9.000 2 0.011
On Glani 30 13 9 5 12.000 2 0.002
On Bhrama 30 7 5 3 6.000 2 0.050
On Tandra 30 7 4 1 9.000 2 0.011

Table 2: Result on Objective parameters

1. On difficulty in falling asleep

Parameter Interval N Mean rank Chi square P Value Remark
Difficulty falling asleep 0th day 30 2.73 44.000 <0.05 S
15th day 2.00
30st day 1.27

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Hiremath A et al: Combined effect of Padabhyanga and Pranayama in Nidranasha

Parameters Negative Ranks Positive rank Ties Total Z value P value Remarks
N MR SR N MR SR
0th - 15th day 15 8.00 120.0 0 0.00 0.00 15 30 -3.873 0.000 S
AT - 15th day 15 8.00 120.0 0 0.00 0.00 15 30 -3.873 0.000 S

2. Difficulty in staying asleep


Parameter Interval N Mean rank Chi square P Value Remark
Difficulty staying asleep 0th day 30 2.33 32.667 <0.05 S
15th day 1.87
30st day 1.63

 

Parameters Negative Ranks Positive rank Ties Total Z Value P value Remarks
N MR SR N MR SR
0th - 15th day 14 7.5 105.0 0 0.00 0.00 6 30 -3.742 P<0.05 S
AT - 15th day ;7 4.00 8.0 0 0.00 0.00 23 30 -2.646 P<0.05 S

3. How satisfied/dissatisfied are you with current sleep pattern?


Parameter Interval N Mean rank Chi square P Value Remark
How satisfied / dissatisfied are you with current sleep pattern 0th day 30 2.48 34.455 <0.05 S
15th day 2.13
30st day 1.38

Parameters Negative Ranks Positive rank Ties Total Z value P value Remarks
N MR SR N MR SR
0th - 15th day 7 4.00 28.0 0 0.00 0.00 23 30 -2.646 P<0.05 S
AT - 15th day  15 8.00 120.0 0 0.00 0.00 15 30 -3.873 P<0.05 S

4. Total Insomnia Severity Index Score


Parameter Interval N Mean rank Chi square P Value Remark
Insomnia Severity Index Score; 0th day 30 14.93 50.876 <0.05 S
15th day 13.83
30st day 12.33

Parameters Negative Ranks Positive rank Ties Total Z value P value Remarks
N MR SR N MR SR
0th - 15th day 20 10.58 217.0  1 14.00 14.00  9 30 -3.612 P<0.05 S
AT - 15th day  24 12.50 300.0 0 0.00 0.00  6 30 -4.373 P<0.05 S

Discussion

Probable mode of action of Padabhyanga[6]

In the centre of the feet 02 Siras are directly connected to eyes. These transmit the effect of the medicines applied over the feet in the form of Abhyanga. These Siras are vitiated by the accumulation of the Malas and cause the Nidranasha. The Abhyanga is exceedingly beneficial to the skin. The aggravation of Vata in Pada can be pacified by Padabhyanga and the practice of Pranayama. Acharya Sushruta in Sarirasthana explains that, out of the four Tiryakgata Dhamanis, each divide gradually hundred and thousand times and thus become innumerable. These cover the body like network and their openings are attached to Romakoopa. Through these the Virya of Abhyanga enters into the body after undergoing Paka with Bhrajaka Pitta in skin and shows its action. Pada Abhyanga nourishes the Adhoga Dhamanis, these in turn nourish the Urdwaga Dhamanis and Tiryak Dhamanis and induce sleep.

According to modern view[7]

The Abhyanga exhibits its action basically on three systems namely vascular system, Nervous system, and Lymphatic system. By fine touch and crude touch. Abhyanga stimulates the tactile receptors and mechano - receptors in the skin. The temperature in the skin increases thus causes kinetic motion in the receptors by which the axons get activated and conducts stimulus through first, second and third order of neurons to the sensory cortex in turn maintains the normal homeostasis of the body by exhibiting neuronal action. In other view, as there is kinetic motion it causes vasodilatation in the subcutaneous vessels by which the Virya of the drug gets absorbed there by improves circulation by increasing blood amino acids that is increasing plasma tryptophan in turn increases neurotransmitter activation causes the secretion of melatonin through which the serotonin is secreted, thus maintains normal mechanism as there is improved circulation there will be parallel improvement occurring in lymphatic circulation thus exhibits the defence action and removes the toxins from cells via blood. Hence, maintains the normal homeostasis. Probably by doing Pada Abhyanga, this increases the intensity of brain waves and decreases the brain cortisone and adrenaline level.


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Hiremath A et al: Combined effect of Padabhyanga and Pranayama in Nidranasha

Probably Pada Abhyanga normalises the two important neurotransmitters Serotonin and Norepinephrine, which regulates a wide variety of Neuropsychological process along with sleep. Thus, it induces relaxation and natural sleep; it impacts a positive effect on eyes.

Action of Pranayama in Nidranasha

Yogic breathing exercises can improve strength of the respiratory muscles which resulted in better tissue perfusion and improved oxygen saturation.

Previous studies of Yoga on health volunteers have shown that after short term Yoga exercises, there is significant increase in the vagal tone, decrease of sympathetic discharge in the form of significantly decreased heart rate response on standing as well as decreased catecholamine levels in plasma. This decreased physiological arousal effect of Yoga has been cited as one of the reasons for less sleep disturbances. Regular practice of Yoga might decrease autonomic over-activity and increase in parasympathetic activity with reduction of oxygen consumption and metabolic rate of prefrontal cortex cells.

Thus, preventing the neuronal loss which might have the beneficial effect in arresting the decline in cognitive function.

Conclusion

The present study found the combined effect of Padabhyanga and Pranayama in Nidranasha in thirty subjects of primary insomnia as statistically significant in subjective parameters like difficulty in sleep initiation, difficulty in staying asleep, early morning awkening, Angamarda, Apakthi, Shirogourava, Jirumbha, Jadyata, Glani and Tandra.

Combined effect of Padabhyanga and Pranayama in Nidranasha has statistically significant effect in reduction in objective parameters like difficulty in falling asleep, difficulty in staying asleep, satisfied with current sleep pattern and total insomnia severity index scale. Padabyanga and Pranayama can be applied as routine activity to prevent falling prey to sleep disorders and also to control and resolve the same problem.

These two tools are surely cost effective, safe and provide additional benefits to one’s health.


Reference

1. Basu M, Chatarjee S, De A, Sinha D, Ahmed A, Mishra R. A study on prevalence of Chronic insomnia and its Association with medical Co morbidities among patients Attending General out patient Department (OPD) of tertiary care Hospital of Kolkatta, India.2017;4(5):6

2. Panda S, Taly AB, Sinha S, Gururaj G, Girish N, Nagaraj D. Sleep -related Disorders among a Healthy population in south India. Neuro India.2012Jan1;60(1):68

3. Vaidya BHP (editor). Ashtanga Hrdayam of Vagbhata, Sutrasthana; Roganutpadaniyadhyaya, Chapter 4, Verse1. Varanasi: Chaukhambha Orientalia; 2015. P.52

4. Charaka Samhita, Ayurveda Deepika Commentary of Chakrapani, edited by; Yadavji Trikamji Acharya, Choukambha Surabharati Prakashan, Varanasi. 2016, Sutrastana 1/35

5. Bastien C. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine. 2001;2(4):297-307.

6. Narayan Sadanand Vete (Sagar), Padabhyanga (Indian foot massage) [Internet], goaayurvedic.com / Padabhyanga.htm, available from http://www.goaayurvedic.com/Padabhyanga.html

7. Terence Vanderheiden, D.P.M., Foot massage and reflexology benefits, [Internet] foothealth.about.com, rebuildermedical.com (cited on 2015), updated December 29, 2014


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