There can be several reasons for insomnia.

The best description of the causes and treatment of insomnia comes from Vidura Niti, a dialogue (samvad) between Vidura and Dhritarashtra.

In the text, King Dhritarashtra said: “O Vidura, Sanjaya has come back. He has gone away after rebuking me. Tomorrow he will deliver, in the midst of the court, Ajatashatru’s message. I have not been able today to ascertain what the message is of the Kuru hero. Therefore, my body is burning, and that has produced sleeplessness.  Tell us what may be good for a person that is sleepless and burning.”

He says, “My body is burning, and that has produced sleeplessness”; this is a typical description of anxiety and related sleeplessness and holds true even today.

Vidura said: “Sleeplessness overtakes thief, a lustful person, him that has lost all his wealth, him that has failed to achieve success, and him also that is weak and has been attacked by a strong person.”

He therefore described five basic reasons for insomnia and these are true, even in today’s science. No new cause has been added in this list of stress-induced insomnia.

The situations are:

1. A thief
2. A lustful person
3. A person who has lost all his wealth
4. A person who has failed to achieve success
5. A person who is weak and has been attacked by a strong person.

Insomnia has been described as a symptom of suicidal ideation and hence, may be a useful indicator of a mind that is stressed and harboring suicidal thoughts.

A person who has lost all his wealth may be desperate. Hopelessness is an internal motivation for attempted suicide. Perhaps this was the case with VG Siddhartha, the founder of Café Coffee Day. His body was recovered from the Nethravathi River near Mangaluru yesterday.

Ayurveda describes sleep as an aggravation of vata & pitta dosha. The number one cause of the same is mental tension, suppressed feelings & acute bitterness.  The above five situations again hold true to this effect.

In Allopathy, the other causes of insomnia mentioned are constipation, dyspepsia, excessive intake of tea, coffee & alcohol and environmental factors such as excessive cold, heat or change of environment. These are in most of the situations the effect and not the cause of insomnia.

Known factors associated with insomnia include:

• Changes in sleep timing: Shift work or jet lag.
• Medical conditions: Respiratory disease (particularly asthma), cardiovascular disease (such as congestive heart failure), endocrine disease, gastrointestinal disease (reflux), pregnancy, sleep apnea, or neurologic disease.
• Drugs: Stimulants (diet pills or amphetamines), selected antidepressants, corticosteroids, diuretics, seizure medicines, and some blood pressure medications.
• Psychiatric problems: Anxiety, mood, or thought disorders.
• Stressful situations: Major life events, employment concerns, or financial stress.
• Substance abuse: Stimulant abuse or withdrawal from alcohol or sedative-hypnotics.
• Lifestyle choices: Drinking alcohol, smoking cigarettes, drinking caffeine-containing beverages (coffee, tea, or soft-drinks).

The treatment of insomnia involves either suppressing the emotions with drugs or root level eradication of stress with proper counseling. Bhagwad Gita, Chanakya Niti and Vidur Niti are the counseling books of ancient era and contain texts and sutras that are relevant even true today.

Here are some of the sutras from Vidura Niti:

• “Do not inhabit a country where you are not respected, cannot earn your livelihood, have no friends, or cannot acquire knowledge. (1.8)
• Do not reveal what you have thought upon doing, but by wise counsel keep it secret, being determined to carry it into execution. (2.7)
• Consider again and again the following: the right time, the right friends, the right place, the right means of income, the right ways of spending, and from whom you derive your power. (4.18)
• A wise man should not reveal his loss of wealth, the vexation of his mind, the misconduct of his own wife, base words spoken by others, and disgrace that has befallen him. (7.1)”

One of the answers to insomnia is learning meditation as described in Patanjali Yoga Sutra or Yoga Vashistha. It is based on the principle of concentrating on the present, which shifts the inner environment from sympathetic to para-sympathetic mode. 20 minutes of meditation morning and evening provides the same biochemical benefit as gathered from 7 hours of deep sleep.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA