E-ISSN:2456-3110

Review Article

Geriatric Sleep

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

An Ayurveda approach for managing Geriatric Sleep Disturbances: A Comprehensive Review

Lekhak P1*, Joshi RK2, Meena HML3, Upadhyay A4, Dalasinghray T5, Kushwaha PS6
DOI:10.21760/jaims.9.8.21

1* Pooja Lekhak, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda Deemed to Be University, Jaipur, Rajasthan, India.

2 Ram Kishor Joshi, Professor, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.

3 H M L Meena, Professor and HOD, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.

4 Abhishek Upadhyay, Assistant Professor, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.

5 Tapaswini Dalasinghray, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.

6 Pankaj Singh Kushwaha, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda Deemed to be University, Jaipur, Rajasthan, India.

Background: Ageing is defined as the progressive deterioration in structure and function of the body organs. In Ayurveda literature ageing (Jara) has been given importance since Vedic period as the natural, progressive phenomenon. In Ayurveda, Sleep (Nidra) is one of the Upasthambha (Sub-Pillar) which is essential for overall health. Ageing causes multiple changes in sleep patterns, and various diseases can further disrupt sleep. Ayurveda describes the physiological increase of Vata Dosha in old age which causes Vata Prakopa in body leading to degeneration of Dhatu (Dhatukshaya) which alter the sleep patterns.

Aim: The paper aims to review common sleep disturbances seen in ageing and their prevention and management through Ayurveda. The study discusses various patterns of sleep during ageing and their possible management through Ayurveda. Primary sleep disorders common in the geriatric population such as; insomnia, obstructive sleep apnea, restless leg syndrome, circadian rhythm sleep-wake disorder was discussed and their management through Ayurveda was reviewed. The selection of Ayurvedic treatment and procedures which nourishes Dhatu and pacify Vata Dosha are effective in managing sleep disturbances.

Result: The study finds that Vatashamak Chikitsa, regulation of Agni, Dincharya, Ritucharya, Vegdharan, use of Rasayana, Panchakarma, Yogasana are beneficial for the management of sleep disturbances.

Conclusion: Sleep disturbances are common in ageing and can be managed efficiently through Ayurveda.

Keywords: Jara, Upasthambha, Vatadosha, Primary sleep disorder, Rasayana

Corresponding Author How to Cite this Article To Browse
Pooja Lekhak, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda Deemed to Be University, Jaipur, Rajasthan, India.
Email: 		Lekhak P, Joshi RK, Meena HML, Upadhyay A, Dalasinghray T, Kushwaha PS, An Ayurveda approach for managing Geriatric Sleep Disturbances: A Comprehensive Review. J Ayu Int Med Sci. 2024;9(8):137-145.
Available From
https://jaims.in/jaims/article/view/3736

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-09 2024-07-19 2024-07-29 2024-08-09 2024-08-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil 13.33 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Lekhak P, Joshi RK, Meena HML, Upadhyay A, Dalasinghray T, Kushwaha PSand 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].

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Introduction

Ageing, defined as the inevitable, progressive, and irreversible decline in structure and physiological function over time and varies widely among individuals. It increases the risk of disease due to changes in biochemical composition, decline in homeostasis, and therefore susceptibility to disease progresses. Consequently, ageing impairs the physiological function of cells, tissues, organs, and body systems.

Sleep is one of the important factor of life which is crucial for health, physical as well as mental relaxation and wellness throughout life. Multiple changes in sleep pattern occurs in ageing. A significant portion of the elderly population experiences sleep disturbances, with 36-69% of older adults reporting such issues.[1] The study conducted among community-dwelling older adults aged 65-79 in California, revealed significant sleep changes in ageing; 30% of older adult slept less than 7 hours per day. Women had a higher prevalence of insomnia (16%) compared to men (11%).[2] With ageing, sleep becomes more fragmented and lighter, characterized by more frequent EEG arousals and awakenings, which leads to decreased sleep efficiency and total sleep time. Both sleep architecture and sleep parameters undergo significant changes throughout ageing. [3]

In Ayurveda, ageing can be related as Jara or Vardhakya. Jara (ageing) is a natural phenomenon like hunger, thirst, or sleep. Ayurvedic literature suggests that while the onset and manifestations of ageing can be delayed, it cannot be entirely avoided. Acharya Charak's Swabhavoparamavada theory of natural destructions assume that death following birth is a natural flow. Acharya Sushruta also identifies ageing as naturally occurring conditions like Kshuta (hunger), Pipasa (thirst), Nidra (sleep), and Mrityu (death). According to Ayurveda literature, sleep (Nidra) is one of the three great sub-pillars (Tryopasthambha) essential for good health and equilibrium. It is important for growth, development, and nourishment of the body, therefore called as Bhutadhatri (nourishes all living beings). Sleep occurs when Tamo Guna (one among the three main qualities which is characterized by darkness and ignorance) increases naturally and the mind and intellect are in deep rest.[4] Proper sleep restores regenerative power of mind and memory.

The significance of sleep is extensively described in the Charaka Samhita, where Acharya Charaka describes that proper sleep leads to cheerfulness, while improper sleep results in unhappiness. This article discusses the Ayurvedic perspective on sleep disorders and the various therapeutic measures recommended for promoting healthy sleep patterns in old age.

Sleep disturbances in Ageing

Structural and physiological changes in the brain during ageing alter sleep patterns, leading to sleep disturbances. Sleep-wake cycle is regulated by two mechanisms: the circadian rhythm cycles and homeostatic processes. The Suprachiasmatic nucleus (SCN) of the anterior hypothalamus controls these rhythms, including sleep-wake cycles, cortisol, and melatonin levels. In ageing, changes in sleep architecture include a decrease in the amplitude of the sleep-wake circadian rhythm and a tendency for desynchronisation of rhythm. This results in lower body temperature and decreased melatonin production, along with declines in cholinergic and serotonergic pathways and neuron numbers in the hippocampus, amygdala, and basal ganglia, all contributing to sleep deterioration.[5]

Common sleep disturbances in ageing include frequent awakenings during night, prolonged time to fall asleep, fragmented sleep, and decreased daytime alertness which impair the sleep quality and ultimately, the quality of life. Underlying medical and psychiatric disorders also contribute to sleep disturbances. Poor sleep quality can disrupt circadian rhythms and trigger metabolic diseases such as diabetes, obesity, and cardiovascular disease.

Sleep is categorized into non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep includes light sleep (stages N1 and N2) and slow-wave sleep (stage N3). Majority of sleep during the night is of the slow-wave variety, which is deep and restful. REM sleep, occurring in cycles of approximately 90-120 minutes, is associated with rapid eye movement, dreaming, and irregular heart rates. NREM sleep repairs the body and helps in regeneration of tissues. Therefore, it is essential part of sleep which strengthens the immune system and boost overall health. Ageing leads to decreased total sleep time, sleep efficiency, and slow-wave sleep, and increased waking after sleep onset.


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These changes reduce homeostatic sleep pressure and circadian signals, resulting in reduced core body temperature and altered sleep and wake times.[6] Common primary sleep disorders in the geriatric population include insomnia, obstructive sleep apnea (OSA), circadian rhythm sleep–wake disorders, Rapid eye movement sleep behaviour disorder and sleep related movement disorders like restless leg syndrome (RLS), and periodic leg movements in sleep (PLMS).[7]

A global meta-analysis of 252 studies involving 995,544 older adults from 36 countries found high prevalence rates of sleep disturbances: obstructive sleep apnea (46.0%), poor sleep quality (40.0%), other unspecified sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%).[8]

Insomnia: The most common sleep disorder where people experience difficulties initiating or maintaining sleep. There is a high prevalence of reported sleep disturbances in the elderly. Multiple factors contribute to the increased risk of developing insomnia in older adults which involves difficulty falling asleep, maintaining sleep, early awakening, and poor sleep quality, leading to daytime symptoms like fatigue or moodiness, often associated with depression, anxiety, and substance intake. 18% of individuals aged 65 years and older affected by insomnia.[9]

Obstructive Sleep Apnea (OSA): It is characterized by recurrent collapse of the upper airway during sleep, leading to reduced (hypopnea) or absent (apnea) airflow causing sleep disturbances, frequent awakenings, loud snoring and daytime sleepiness.[10] Also associated with medical comorbidities like obesity and heart failure. Its prevalence increases significantly with age. In older adults, OSA can affect up to 70% of men and 56% of women.[11]

Restless leg syndrome (RLS): More common in females, characterized by unpleasant sensations in the legs with an intense urge to move, especially at night resulting in sleep initiation or maintenance problem. It may be idiopathic or secondary to other medical condition like iron deficiency anaemia, peripheral neuropathy etc.[12] Prevalence increases with age, often linked to dopaminergic neural functioning. Estimated prevalence is of 10-35% above 65 years of age.

Most individuals with RLS also exhibit Periodic Limb Movements (PLMs) during sleep, characterized by repetitive, stereotyped movements typically involving the big toe and ankle, and sometimes the knee and hip. However, PLMs can also occur without RLS in approximately 70% of cases.[13]

Rapid eye movement sleep behaviour disorder (RBD): It is a REM sleep parasomnia characterized by individuals acting out their dreams through behaviours like talking, shouting, limb thrashing, and punching, primarily affecting older adult males.

Circadian rhythm sleep-wake disorders (CRSWD): It occur when sleep timing is disrupted due to changes in circadian rhythms or a mismatch between an individual’s internal body clock and their required sleep schedule. In ageing, the circadian rhythms become weak and become less responsive to external stimuli.[14]

Therefore, in older age, typical changes in sleep architecture and continuity includes reduction in slow-wave sleep (SWS), a decrease in the percentage of rapid eye movement (REM) sleep, a reduction in total sleep time (TST), and decreased sleep efficiency (the proportion of time in bed spent asleep).

Additionally, there is often an increase in sleep onset latency (the time it takes to fall asleep) and decline in circadian oscillations, such as reduced melatonin peaks, leads to advanced sleep phase syndrome, characterized by earlier sleep onset and waking times. Bright light therapy is recommended to counteract reduced light exposure in older adults.

The weakening of the internal circadian clock, particularly the suprachiasmatic nucleus, results in disrupted sleep patterns and affects various physiological and behavioural functions, including energy metabolism and locomotor activity. Ageing involves complex molecular and cellular changes, such as mitochondrial dysfunction and genomic instability, increasing the risk of metabolic disorders, cardiovascular diseases, neurodegenerative diseases etc.

Telomere deterioration is associated with insomnia in older adults, and sleep disturbances may accelerate cellular ageing. EEG studies show decreased delta power and increased beta wave power in older individuals, linked to sleep initiation difficulties and cortical arousal. [15]


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Ayurveda and Sleep Disturbances

Ayurvedic texts highlight the importance of sleep and describe various measures for preventing ageing and related disorders (Jarajanya Vikar). Key factors affecting healthy ageing include Kalapramana (time), Prakriti (constitution), Dosha, Ahara (diet), Achara (behaviour), and Jatharagni (digestive fire). Ayurveda, based on Tridosha theory, emphasizes the balance of Vata, Pitta, and Kapha doshas, which determine sleep quality. Vata dominance in old age leads to increased awakenings and daytime naps in persons over the age of 60 years.[16] In Ayurveda ageing (Jara) is the result of Kala (time) and Parinama causing physical and mental transformations. Jara or ageing, is characterized by a natural decline in physiological functions of body. The processes of tissue formation (Dhatu synthesis) also diminish, leading to Dhatu Kshaya, or the degradation of bodily tissues. The predominance of Vata Dosha exacerbates Dhatu Kshaya, accelerating degenerative changes due to the deterioration of Rasadi Dhatus (major structural component of body), Srotas (body channels), and Agni (digestive and metabolic fire). Consequently, both the quantity and quality of all Dhatus decrease. This degradation also impacts sensory and motor functions, reducing the perception abilities of the Indriyas (sensory system). Moreover, ageing is associated with declines in physical strength, coordination, cognitive functions, memory, and intellect.

Preventive measures in Ayurveda

Ayurveda offers a comprehensive approach to addressing sleep disturbance in the ageing. The primary focus is on balancing the Vata Dosha, which is the predominant factor in most geriatric problems, including insomnia, irritability, and degenerative changes. Ayurvedic texts describe numerous preventive measures and treatments for sleep disturbances and ageing-related issues. Some of them are described below;

Rasayana Therapy

Rasayana, described in Ayurveda literature represents a specialized therapeutic approach aimed at delaying aging, promoting health, and enhancing longevity. It includes various herbal preparations, dietary guidelines, and lifestyle practices aimed at rejuvenating the body's tissues, enhancing vitality, and maintaining overall well-being.

Particularly effective in addressing age-related ailments (Jarajanya Vikaras). Rasayana therapies nourish bodily tissues (Dhatu) and promote longevity. Rasayana, according to Acharya Sushruta, stabilizes lifespan, enhances strength, and prevents diseases by rejuvenating bodily functions. It targets the Rasa Dhatu (Primary product of digested food), Agni (digestive fire), and Srotas (channels of the body). Acharya Charaka has described various drugs possessing Rasayana effect and emphasizes on the concept of Rasayana therapy for mental health called Medhya Rasayana which includes plants like Centella asiatica, Glycyrrhiza glabra, Tinospora cordifolia, Convulvus pluricaulis. These plants alleviate stress, anxiety, and depression, supporting mental well-being in geriatric populations. Ayurveda also describes certain drugs/herbs that produce calming and relaxing effect on mind by increasing the level of neurotransmitter like serotonin and melatonin hormone thereby inducing sound sleep such as Brahmi (Bacopa monnieri), Shankhpushpi (Convulvus pluricaulis), Vacha (Acorus calamus), Sarpgandha (Rauvolfia serpentina), Ashwagandha (Withania somnifera) and Jatamansi (Nardostachys jatamansi) etc. They have calming effects, beneficial for treating insomnia and other sleep disturbances.

Table 1: Specific Rasayana Herbs for Sleep Enhancement

Rasayana drugsMode of action
Shankhpushpi (Convulvus pluricaulis)Promotes the intellect, Bala (strength), Varna (Complexion), Ayu (Lifespan), beneficial in sleep disturbances by calming effect on mind.[17]
Brahmi (Bacopa monnieri)Medhya Rasayan, neuroprotective action, intellect promoting drug and restores memory power and induces sleep.[18]
Ashwagandha (Withania somnifera)Hypnotic and sedative action, promote healthy sleep patterns, delays ageing process. Provide strength and nourishment to body.[19]
Vacha (Acorus calamus)Promotes the intellect, memory, relaxing and calming effect on mind, thus induces sleep, aids in mental development.[20]
Jatamansi (Nardostachys jatamansi)CNS depressant action (sedation), calms the mind by relieving anxiety and induces sleep due to its Nidrakar (Sleep inducing) property.
Tagara (Valeriana wallichii)Tagara is having the property ofNidrajanana(sedative and hypnotic). It rejuvenates and relax nerves.
Mandukaparni (Centella asiatica)Inhibits the memory impairment and has neuroprotective action.

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Therefore, concept of Rasayana covers welfare of structure, function and psychological aspect of human body both in health and diseased condition.

Panchakarma Therapy

In Ayurveda, Vata Dosha is considered main aggravating factor in geriatric conditions, leading to issues such as insomnia, mobility disturbances, and irritability. Therefore,Vata Shamaka Chikitsa, like Basti (enema therapy) and Snehana (oleation therapy) are primary aim of treatment. Panchakarma therapy has both health promoting and therapeutic role in cleansing body toxins. It includes cleansing body toxins like Periodical detoxification, purification, rejuvenationtherapies and nourishing deeper tissues, there by pacifying age-related disturbances. It includes detoxification and rejuvenation therapies like Matravasti (oil enemas), Abhyanga (oil massage), and Shirodhara (oil pouring on forehead) to balance Doshas, reduce stress, and enhance sleep quality.

Basti

Basti Karma involves administering medicinal substances via rectum and retaining them for a specified duration. Matrabasti (Therapeutic enema) is highly effective in managing geriatric conditions, primarily due to its potent Rasayana (rejuvenative) properties. Basti helps in reducing hyperactivity of Vata, thereby alleviating pain, improving mobility, and enhancing sleep quality. It works by delivering medicated oil directly into large intestine, where it is absorbed and circulated throughout body by nourishing and rejuvenating tissues. Acharya Sushruta compared mechanism of Basti to water nourishing a tree's roots and spreading to all parts of tree. Similarly, medicated Basti spreads from Pakwasaya (large intestine) through appropriate channels, providing systemic benefits.[21,22]

Shirodhara

Sirodhara is a therapeutic procedure in Ayurveda that involves continuous, rhythmic pouring of herbal medicated oil or liquid extracted from above mentioned plants onto forehead. This technique is particularly effective in reducing hyperactivity of nerves, alleviating stress, and calming mind. By stimulating pituitary gland, Sirodhara promotes proper functioning of other endocrine glands, thereby enhancing hormonal balance and inducing better sound sleep.[23]

Abhyanga

In the context of Dinacharya (daily regimen), Abhyanga (oil massage) should be performed daily as it nourishes tissues, strengthens the body, and enhances Agni (digestive fire). Special emphasis is given in the head (Shiroabhyanga) and feet (Pada-Abhyanga). Sleep disturbances and night time awakening can aggravate Vata Dosha and decrease Snigdha Guna. Therefore, oil massage on the feet reduces the Ruksha Guna of Vata Dosha, facilitating natural, sound sleep. Abhyanga strokes and rubbing establish the free flow of energy and control Prana, which governs the sensory and motor systems. A study found that massage with moderate pressure increases tryptophan levels. According to the National Sleep Foundation, tryptophan is an essential sleep-inducing amino acid necessary for producing melatonin, and a small percentage in producing serotonin.[24] Abhyanga also reduces stress, and anxiety by lowering cortisol levels, epinephrine, heart rate, and blood pressure.

Yoga and Pranayama

Daily practice of Yoga, meditation, and Pranayama (breathing exercises) helps delay the ageing process, improve sleep quality and improve physical and mental health by enhancing flexibility, reducing anxiety, and promoting a balanced state of mind and body. The integration of Shirodhara with these daily practices offers a holistic approach to managing stress, improving sleep quality, and maintaining overall well-being. Several studies have investigated the impact of Yoga on sleep. One study found that Yoga reduced the time required to fall asleep and increased total sleep duration by reducing arousal and anxiety manifestations.[25]

The practice of Yoga and Pranayama has demonstrated a reduction in plasma catecholamine levels, reduction of blood pressure, alleviating anxiety, decreasing sleep disturbances, and improving the serum lipid profile. In various randomized controlled trials (RCTs), elderly participants who practiced Yoga for six months experienced a significant reduction in the time to fall asleep, decreased night time sleep disturbances, improved sleep quality, and reduced use of sleep medications compared to control groups. Regular yogic breathing exercises have been found to strengthen upper airway muscles, thereby decreasing sleep disturbances.[26]


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Additionally, Yoga exercises improve joint flexibility, prevent the decline in physical function, and enhance the quality of life (QOL) of elderly individuals.[27]

Ayurveda and Circadian Rhythm

The body has its own natural rhythm, essential for a healthy life. Adopting healthy behaviours and following a proper daily regimen (Dinacharya) and seasonal regimen (Ritucharya) can restore disturbed natural rhythms. These regimens regulate biological rhythms for maintaining sleep patterns. Maintaining circadian rhythm involves waking up during Brahmamuhurta (two hours before sunrise) and engaging in specific activities at prescribed times, and following a structured routine throughout day.

This practice is designed to help one lead a healthy and disciplined life, reduce stress, and purify and detoxify the body. The practice of Dinacharya also aligns with the natural circadian rhythm, which is explained in Ayurveda through the Tridosha cycle, which maintains bodily functions and homeostasis. Individuals can maintain synchronicity with their circadian rhythms, promoting health, vitality, and immunity while delaying ageing.

Various factors such as Desh (place), Kala (time), Ahara (diet), Vihar (lifestyle), Agni (digestive fire), and Ritu (seasons) can affect the equilibrium of these Doshas. Therefore, diet and regimen must be according to the body's Dosha status in each season to maintain circadian rhythm and overall health.

This balance controls daily routines, including sleep patterns, by influencing hormone levels and body temperature. Ritucharya (seasonal regimen) involves dietary, behavioural, and habit changes in accordance with seasonal variations. Environmental changes in various seasons also affect the Tridosha balance. Studies indicate that Seasonal Affective Disorder (SAD) results from circadian cycles improperly adapting to the lengthening of the day as the seasons change.

Disruptions in Agni (digestive fire), Vega Dharana (suppression of natural urges), improper Ahara (diet), and Nidra (sleep) can desynchronize circadian cycles.[28] Modern science describes natural sleep as a manifestation of the rhythmical activity of nerve cells. It also recognizes circadian rhythm’s role in regulating hormone levels, body temperature, and metabolism.

Among several Dinacharya practices, such as Pratimarshnasya (nasal application of medicated oil), Shiroabhyanga (head massage), Pada-abhyanga (foot massage), Abhyanga (body massage), Snana (bathing), Udvartana (powder massage), and Utsadana (herbal paste massage), are documented to promote good sleep and overall health.[29] For example, Pratimarshanasya (low dose medication through nasal route) with Anu oil, known for its Tridoshahara (balancing all three Doshas) properties and boosts the function of all body parts above the clavicle. Chakradatta text recommends administering Pratimarshanasya at the end of the day (before bedtime) for its Strotoshuddhi (channel-cleansing) and Sukh Nidradayak (sleep-inducing) effects, with 2-2 drops in each nostril.[30]

Udvartana, the procedure of massaging the whole body with Churna (powder) below the neck in a direction opposite to hair growth with some pressure. It has various therapeutic effects, including Gaurvahara (removing heaviness in body), Vatahara (alleviating Vata), and Strotorodhahara (clearing channels). It enhances blood circulation and boost natural sleep. Sadvritta is defined as moral reasoning, a code of ethics, or good conduct which is essential for daily living and maintaining a balanced state of mental and physical health. It aims to develop a harmonious balance between mind and body, enhancing personal growth. Therefore, maintaining mental health is as crucial as physical health in elderly individuals, making the practice of Sadvritta is helpful for mental development.

Behavioural Interventions (Achara Rasayana): Achara Rasayana involves behavioural modifications that act as psycho-immune modulators, reducing stress and preventing free radical release.

Many studies and researches have explored the relationship between bathing and sleep. Evening warm baths, by manipulating body temperature before sleep, positively impact sleep quality for healthy elderly individuals with insomnia (Liao WC. Int. J Nurs Stud. 2002). Warm water stimulates the hypothalamus (thermoregulatory system) in the brain, regulating body temperature and the sleep-wake cycle. The hyperthermic action after a bath induces vasodilation, increasing blood flow and eliminating metabolic waste, which may help reduce stress, anxiety, and depression.


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Discussion

Ageing is a natural, progressive and inevitable phase of human life. It is accompanied by significant structural and physiological changes in the brain, impacting sleep quality. Sleep can be influenced by various factors, including age, lifestyle, daily routines, diet, and environment. Poor sleep patterns can trigger age-associated pathological conditions, hastening the ageing process. Various researches indicates that insufficient sleep disrupts circadian rhythms, leading to negative health outcomes such as obesity, cardiovascular disease, and cognitive impairment. Moreover, lack of sleep is correlated with an increased risk of glucose intolerance, which predisposes individuals to diabetes, obesity and other metabolic disorders. Common sleep disturbances in the elderly like insomnia, sleep apnea, circadian rhythm disturbances etc. lead to a decline in overall health and quality of life.

In old age, although disturbance in equilibrium of three Doshas is common with a predominance of Vata dosha in this age. Quantity and quality of all the Dhatu decreases. The combination of Vata dominance and deterioration of Rasadi Dhatu, Srotas and Agni are responsible for the various degenerative changes, Dhatukshaya and process of decay in the body. Rasayana therapy, a rejuvenative treatment in Ayurveda, plays a significant role in promoting health and longevity. Specific Rasayana herbs such as Ashwagandha, Brahmi, and Shankhpushpi, Vacha, Tagar etc. have been traditionally used to enhance sleep and delay aging. Health is regulated by an internal clock synchronized with the 24-hour light-dark cycle.

Ayurveda outlines daily (Dinacharya), night (Ratricharya), and seasonal (Ritucharya) routines, prescribing optimal times for activities like waking, sleeping, and eating.[31] These harmonious routines maintain circadian rhythm synchronicity, promoting health, vitality, and immunity, and delaying ageing. These routines include cleansing procedures, bowel habits, yoga, breath practices, and massage. These regimens should be adopted as drugless therapy (Adravyabhuta Chikitsa) and lifestyle modalities to maintain health, improve work efficiency, and ultimately reduce sleep disturbances. Adherence to these practices minimizes acute and chronic conditions that negatively influence the ageing process.

Charaka Samhita (the ancient text of Ayurveda) highlights various remedies for sleep disturbances such as Abhyanga (oil massage), Utsadana (massage with herbal powders), Snana (bathing), consumption of meat soup from domestic and aquatic animals, Shalichawal (a variety of rice), curd, milk, and Sneha like ghee and oil also, Netratarpan (pouring oil around the eyes), applying Lepa (herbal pastes) on the body, using comfortable beds and maintaining regular sleep timings.[32]

Ayurveda is a holistic science aimed at maintaining Dhatusamya, a state of equilibrium in anatomical, biological, physiological, mental, and spiritual functions. Hence a balanced state of Dosha, Dhatu, Agni, and metabolic wastes (Mala) constitutes homeostasis in Ayurveda that leads to proper sleep and graceful ageing. By focusing on achieving a balance between mind and body, Ayurveda aims to address these sleep imbalances, promoting overall health and well-being, particularly in the ageing. Modern medical treatments for sleep disturbances often include pharmacological interventions, cognitive-behavioural therapy, and lifestyle modifications. Integrating Ayurvedic practices with these modern approaches can provide a holistic solution.

Conclusion

In conclusion, sleep (Nidra) is a fundamental pillar of health in Ayurveda, crucial for maintaining physical and mental well-being. Through the implementation of daily routines, dietary practices, and specific treatments, Ayurveda provides a comprehensive approach to managing sleep disturbances and promoting a healthy, balanced life. Ayurveda’s holistic approach, incorporating Dinacharya, Ritucharya, Rasayana therapies, and other practices, promotes a healthy lifestyle that supports circadian rhythm, enhances sleep, and delays aging. This approach optimizes bodily functions and supports mental growth in elderly individuals and can significantly improve the quality of life and promote healthier ageing.

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