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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 3-9

Treatment of Tūkkamiṉmai (Insomnia) Through Siddha Yoga Practice Tirumūlar Piraṇāyāmam: A Case Report


1 Department of Siddhar Yoga Maruthuvam, Government Siddha Medical College, Palayamkottai, Tirunelveli, India
2 Department of Gunapadam, Government Siddha Medical College, Palayamkottai, Tirunelveli, India

Date of Web Publication11-Oct-2021

Correspondence Address:
Joshil
Department of Siddhar Yoga Maruthuvam, Government Siddha Medical College, Palayamkottai, Tirunelveli
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Introduction: Tūkkamiṉmai (insomnia) is an emerging factor in this current scenario among adults. In India, sleeplessness is more prevalent among adolescent age group population because of modified life styles activities. 29 years old female visited the Department of Siddhar Yoga Maruthuvam of Government Siddha medical college with complaints of sleeplessness (Tūkkamiṉmai) over the period of past 3 months. Methodology: Her pulse (Nāţiparicōtaṉai) was predominating in Pitta vātam. The Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness scale has been used as a standard tool to measure the status of sleep and sleepiness status respectively. Diagnosed as Tūkkamiṉmai (insomnia) and provided Siddhar Tirumūlar Piraṇāyāmamas recommended by Siddha text Siddhar Sirappu Maruthuvam. Results: On seventh day of practicing of Tirumūlar Piraṇāyāmam, her sleep got to normal without any disturbances and followed the case of 3 weeks. After starting the intervention, she got a good sleep from the 1st week itself. In follow-up, the quality of sleep and sleepiness stage improved well in the 3rd week. The Sleep Quality Scale and Sleepiness Measurement Questionnaire was used before and after the practice of Tirumūlar Piraṇāyāmamfor sleeplessness. Conclusion: This study provides us a lead to initiatelarge-scalestudies (case series, observational studies, RCTCs etc) for sleep regulation with Yoga. The Siddha Tirumūlar Piraṇāyāmam practice could make a definite impact on sleep regulation centers and neuronal systems over the body. Through holistic care, Siddha Yogam along with proper clinical history, clinical diagnosis, the emerging sleep disturbances and rehabilitation from electronic syndromes are not a height for the Siddhar Yoga Maruttuvam.

Keywords: Cittar Yōka Maruttuvam, Electronic screen syndrome, Epworth Sleepiness scale, Pittsburgh sleep quality index, Tirumūlar Piraṇāyāmam


How to cite this article:
Joshil, Merish S, Poongodi Kanthimathi A S. Treatment of Tūkkamiṉmai (Insomnia) Through Siddha Yoga Practice Tirumūlar Piraṇāyāmam: A Case Report. J Res Siddha Med 2019;2, Suppl S1:3-9

How to cite this URL:
Joshil, Merish S, Poongodi Kanthimathi A S. Treatment of Tūkkamiṉmai (Insomnia) Through Siddha Yoga Practice Tirumūlar Piraṇāyāmam: A Case Report. J Res Siddha Med [serial online] 2019 [cited 2021 Dec 3];2, Suppl S1:3-9. Available from: http://www.jrsm.com/text.asp?2019/2/3/3/328048




  1. Introduction Top


Tūkkamiṉmai or Nittiraipaṅkam (insomnia) is an emerging factor in this current scenario among adults. In India, Sleeplessness is more prevalent among adolescent age group population because of modified life styles activities.[1] Insomnia is a clinical condition of difficulty in falling asleep or being awaken over the night. In this condition, the concerned patient may be associated with few sleeping disorders such as restless leg syndrome and nightmares etc. Insomnia is classified by International Classification of diseases (ICD 10) under Episodic and paroxysmal related sleeping disorder (G.47).[2]

1.1 Nittiraipaṅkamin Siddha

According to Siddha hygiene and preventive medicine (nōyillāneṟi), Nittiraipaṅkam is characterized by poor quality of sleep which is mainly due to disturbances. This can be directly correlated with the term insomnia[1]. Apart from this, Siddha literatures ‘nōyillāneṟi’ describes few more clinical conditions of Sleeping disorders such as Nittiraiinmai (complete absence of sleep), Anittirai (hypersomnia), Pakalnittirai (sleeping in daytime) etc. [3].

Sleep disorder has been classified by International Classification of Sleep Disorders (ICSD) as more than 50 types[2]. Insomnia is one of the major disorders under this category. The adult age group between 18-30 years were mostly affected for this insomnia associated symptoms. Approximately 20-22% of global population are affected by Insomnia disorder. In India, nearly 28% of population suffer from insomnia and 10% are under occasional insomniac symptoms. Majorly urban population has major prevalence than that of population from rural sector[4].

1.2 Fourteen vital reflexes of body

In Siddha system of medicine, fourteen involuntary reflexes listed are Abanan, Urination, bodily faecal matter, hunger, thirst, Sneezing, Cough, Vomiting, Yawning, lacrimation, Sleep, Sperm/Ovum and breathing[3]. These reflexes are considered as involuntary reflexes which are not advisable to intact voluntarily, which may lead to health consequences. Out of the fourteenreflexes, sleep is also one of the important factors and the consequences of altered sleep was well documented in Siddha literature. The health consequences such as heaviness of the head, altered hearing may lead to deafness in chronic habitual and altered speech (Aphasia).

The diagnosis was arrived based on WHO guidelines for Insomnia related behavioural science. The basic criteria for the gold standard diagnosis used for the study was a) Complaint of poor sleep pattern expressed by patients b) Difficulty in falling asleep within 30minutes c) awakening during night sleep at least for 2 times d) day time irritability, drowsiness and fatigue e) any of one category like physical problem, lifestyle changes or on any psychiatric treatments.[5]

The insomniac patient may suffer from fatigue and physical tiredness on the next day. The concept of Tokkaṇam (Bodily massaging with oil application)[6] has been recommended by the literature to rejuvenate the bodily circulation system. Eventually this supplies more oxygen components to all parts of body. Based on this concept, Tirumūlar Piraṇāyāmam[7],[8] was advised for this case.[9]


  2. Methodology Top


2. 1 Patient Information

A case of 29 years old female from Tirunelveli city, working as an IT professional, Unmarried and from a Middle-class family[8]. The case came with the complaint of sleep disturbance for a period of past 4 months. Her complete gynecological profile was normal. There is no such notable change in her menstrual health, not a known case of diabetes mellitus, hypertension, asthma and thyroid disorders. Blood pressure was normal in state.

The Patient had the habit of consuming fast food twice a week and used to work with desktop for more than 8-10 hours, she used her mobile phone for at least 2-3 hours during night-time. No significant family history. Her appetite was very poor and for most of the time she skipped the night meal because of fear of putting weight, but sheweighed 62kg. There is no psychologicalrelated history.

Previously she had continued her treatment in a private allopathic hospital in Tirunelveli and she was treated with sleeping pills for a period of two to two and half months. But she got good sleep when using these drugs. During the intermediate skipping of tablets, she had persistent sleeplessness. After the withdrawal of the medicines there was a relapse after two weeks. When using the sleeping pill (Lorazepam 1mg, aCNS (Central nervous system) depressant, she had parasomnia (feeling of drowsiness) in the daytime mostly during working hours).

2.2 Clinical Findings

Primarily carried out the Siddha line of diagnostic tool namely eight fold diagnostic methods which are as follows: Nāţiparicōtaṉai (pulse reading), Sparicam (skin tone), (tongue), Niṟam (colour of skin), Moḻli (speech), Villi (eyes), Malam (faecal matters) and Mūttiram (urination).[10] Dryness/mild redness of the eye was observed and she complained of the eye irritation (probably due to dryness) when falling asleep under the ceiling fan on interrogation. The Single case is from a

Marutam (Ancient geographical classification) geographical area presented with Pitta vātamin Nāţiparicōtaṉai (Traditional Pulse reading

2.3 Timelines

On April 2, 2019 she has visited Siddhar Yoga maruthuvam department for Insomnia and she had withdrawn her allopathic CNS depressant medicines on March 15, 2019 and the diagrammatic representation of the study is mentioned in [Figure 1].
Figure 1: Case reporting and treatment procedure

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2.4 Laboratory Assessment

She was checked for routine haematology parameters and the results were completely normal. Her haemoglobin was 13.5mg/dl. Based on WHO sleeplessness criteria, the diagnosis was confirmed as mentioned in the [Table 1].
Table 1: Assessment of WHO sleeplessness/Insomniac criteria

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2.5 Therapeutic Intervention

Non-Pharmacological therapeutic interventions like Yogasanam and therapeutic oil bathing procedures was advised for the case for 3 weeks. Chukkuthylam was selected based on three humour concept which eventually stabilizes altered tiritōṭam from the body [Table 2]. Oil bathis one of the general habitual practice mentioned in Siddha literature to maintain healthier life (Noi Anugavithi). For the patient to cope up with lifestyle based on Siddha verse (Tamil) Vaigaraiyil Thuyilezal, literally means to wake up in the early morning), a treatment plan was made with Cūriyanamaskāram(Sun salutation). The patient adopted the scheduled intervention as mentioned in the [Table 2].
Table 2: Yoga Protocol

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2.6 Assessment tool

Before the therapeutic intervention, the participant was subjected to Pittsburgh sleep quality index (PSQI),[12] which is a sleep condition indicator (composed of 9 standardized questions), developed by University of Oxford to measure the Quality of Sleep in night time.[13] Each question carries 0-4 point (a scale of 0, 1, 2, 3 and 4) and the final summarized scoring could be ranging between 0-36 Points followed by the sleep quality has been categorized as mentioned in [Table 3].[14]
Table 3: Guide for evaluation of Sleep quality based on PSQI Scale

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In addition, the Epworth Sleepiness Scale (ESS consist of 8 simple questions) was used to measure the sleep feel in day time.[15] Whenever the night sleep get disturbed, relatively there is a chance of getting tired and falling asleep or sleepiness in the day time.[16] Based on this, the ESS was used to measure the state of day time sleepiness. It consists of preferable 8 different situations (8 questions) in which the rate of tendency to become sleepy or chance of dozing are measured using the scale ranging from 0, no chance of dozing/Sleepiness to 3, high chance of dozing/Sleepiness [Table 4]. The score ranged between 0-24.[17]
Table 4: Guide for evaluation of Sleepiness through ESS index

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2.7 Information retrieval

The information from PSQI and ESS scale was collected through face to face interview and filled by the physician based on her reply to the questions. This case report was drafted based on Standard Reporting CARE guidelines (CAseREporting).


  3. Outcome and Followup Top


The outcome of the therapeutic yoga intervention “Siddha TirumūlarPiraṇdyāmām” was measured based on the Pittsburgh Sleep Quality Index (PSQI) for Quality of sleep and Epworth Sleepiness Scale (ESS) for sleepiness. In PQSI scale, score of 14 (46.67 %) in Pre- treatment and score of 24 (80%) [Figure 2], in post treatment was observed, the quality of sleep gets increased,after the practice of TirūmularPiraṇāyāmamand oil bathing procedure when compare to the pre-treatment score tabulated in [Table 5]. At the same time, the sleepiness scale score was 43.3% before the treatment, felt sleepy during daytime and during the activities like watching television, sitting, and working etc. Whereas Post treatment survey shows 23.3%, the sleepiness score reduced as well as patient felt better at this time. During this treatment, she was advised to visit once every seven days at the Out-patient department of Siddhar Yoga Maruthuvam, Government Siddha medical College, Palayamkottai, Tamilnadu, India.
Figure 2: PSQI Score on Quality of sleep

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Figure 3: ESS Scale on Sleepiness index

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Table 5: Outcome score ofPiraṇāyāma intervention for Sleeplessness and sleepiness conditions

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3.1. Adverse and unanticipated events

During the treatment process, no adverse events were observed. Throughout the follow- up period, we did not notice any untoward symptom.

3.2. Informed consent

Informed consent was obtained from the patient.


  4. Conclusion Top


The concept of Tirumūlar Piraṇāyāmam is a hidden treasure for Siddha physician which is highlighted by sage Tirumūlar in his Tirumantiram. Lot of research works has been going on this Tirumūlar Piraṇāyāmam over the globe. This case report shows the improvement and could alleviate Sleep associated symptoms and stress etc. Furthermore, clinical validation studies are to be carried out in near future.

FINANCIAL SUPPORT Nil

CONFLICT OF INTEREST None declared

CONTRIBUTORS

First Contributor executed the study and drafted the manuscript and Second contributor designed the concept and literary review. Third contributor guided the study and reviewed the final manuscript.



 
  References Top

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Bankar MA, Chaudhari SK, Chaudhari KD. Impact of long-term Yoga practice on sleep quality and quality of life in the elderly. J Ayurveda Integr Med 2013;4(1):28-32.  Back to cited text no. 14
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
1. Introduction
2. Methodology
3. Outcome and F...
4. Conclusion
References
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