A Case of nonorganic insomnia treated with homeopathy

Dr Arun Kumar

Abstract: A Male patient aged 65 years presented with the complaints of difficulty in initiating and maintaining sleep since 3months.NUX VOMICA was selected and prescribed based on the presenting symptoms and psychogenic condition of the patient.Significant improvement in sleep was seen within a week

Keywords: homoeopathy,insomnia,non organic,Nux vomica

Introduction: Insomnia is the most common sleep disorder .It may be transient or persistent.Population surveys show, in 1 year prevalence rate of 30 to 45 percent in adults.In persons to function adequately in day to day life require a certain hour of sleep in short sleepers its about 6hrs.In long sleepers its 9 hours¹

Diagnosis: Severity of insomnia is judged along dimensions of frequency ,intensity,&duration.As well as impact on daytime functioning & quality of life.generally,criteria for severe and chronic insomnia are minimum duration of 6months with problems presenting three or more nights per week.Restlessness,irritability,anxiety,daytime fatigue,&tiredness commonly accompany such presentations.mild and moderate insomnia may be diagnosed where problems are less intrusive.²

Under DSM-5 Coding note:The code 780.52 (G47.00) applies³

Clinical features for a definite diagnosis:

1. The complaint is either of difficulty falling asleep or maintaining sleep or of poor quality of sleep
2. The sleep disturbance has occurred at least 3 times /week for atleast 1 month
3. There is preoccupation with the sleeplessness & excessive concern over its consequences at night & during the day
4. The unsatisfactory quantity & quality of sleep either causes marked distress or interferes with ordinary activities in daily living⁶

Risk factors:vulnerability to insomnia, sleep disturbance are more likely to occur when predisposed individuals are exposed to precipitating events,such as major events(eg:illness,separation)or less severe but more chronic daily stress.³

Case report:
Patient is obstinate , independent and doesn’t like to depend upon anyone.pt has a small hotel in town, which he manages all by himself.He himself cooks,serves & cleans.Recently since the covid pendamic his business is down ,gradually he started loosing sleep & Since 3 months he is unable to initiate or maintain proper sleep.

Life space
Childhood:patient comes from very poor family background,his parents were both daily wage labourers,as a chid he was the most mischievous one among the 4 siblings , a hardihood character, thus his friends used to send him in front when there was any confrontation ,due to financial issues at home he could only continue his study upto 2 STD,Later he joined with his dad for work.he  felt that he can’t work under his dad anymore.when he was 16 years he started to work in mangalore harbour

Adolsence: he used to go in boat to catch fish ,where he used to get  small share if the catch was good.he worked there for 5 years later stopped.Because he had to stay in sea for 3 or 4 days.which he didn’t not like.later he started going for catring work & got married at the age of 30

Adult life:he started working in hotels and learned cooking, afterwards he started his own hotel.His business was going all good he built house gave his kids good education,they are all well settled.he has 3 sons eldest work in dubai,2 son works in pune IT field, youngest son stays with him who work in gas agency.He doesn’t want to depend on his sons  and he wont ask his sons for money.Also sons think dad has money &  since the pendamic he started worring what if his health  start deteriorate,what if all his saving goes off in Hospital bills,he started worring for small small things and started to lose sleep initially.he is a preson who gets angry easily ,contradiction aggravates him ,doesn’t share much with anyone,doesn’t like to be alone,nor wants much company,love to be with family but doesn’t like to speak much .

Some of the key features

Patient is malicious,when angry expresses himself without much much inhibition,gets anger when obliged to answer,seeks security and repose,he wants it and wants it back fast.patient is impatient,he is expressive when conversation is built, emotional person, quarrelsome especially with his neighbours at home,Concerned with occupation and businesss,fear of poverty,Ailments from business downfall,Desires spicy food,quiet,desires repose & tranquility,besides oneself,quiet ameliorates.

Lean,thin,compact constitution

Compelled to stimulate his memory to all details,goes home thinks about it,lies awake ,confused with the whirl of business & affairs of day

Patient appears more of Loganiaceae family

Characteristics

1. Sensitivity to sound, light,and other external impressions
2. Emotional Excitability,slightest of emotion excessively aggravates their general status,Generally aggravated by stress,joy ,sorrow
3. Want to be left alone:do not wish to be in anyone’s company
4. Loves solitude,talks to oneself when alone
5. Fear of bad news, failure,accidents,losing possessions
6. Mental irritability,slightest of emotions irritates
7. Nervousness
8. Easily angered,quarrelsome,abusive,use of bad language
9. Intolerance to contradiction ⁴

Family history: father was HTN, Expired due to old age

Mother was healthy expired due to old age

Siblings 3 all are healthy

Personal History: appetite-reduced nowadays

Thirst- thirsty (drinks about 3-4 litres of water/day)

Bowel/Bladder-Regular

Thermals:chilly

VITALS:

• BP-13O/90MMHG
• PULSE:78BPM
• Weight:62kg
• Height:5’0 feet
• Temp:98 F
• SPO2:99%
• RR:18BPM
• CHEST:Clear,NVBS HEARD

INVESTIGATION: ALL THE PARAMETER ARE NORMAL

MENTAL STATE EXAMINATION:

1.GENERAL APPEARANCE :

1. BODY BUILT:Moderately built

b.HYGIENE & GROOMING:Maintained

1. GROOMING:Well Groomed.

d.Motor activity: normal

e.Social Manner: Good

f.Rapport: easily attained

2.SPEECH:

1. Rate & quantity: rapid & Less

b.volume & tone:normal

c.Flow & Rhytm: smooth

3.MOOD:Fine AFFECT:Sad,Worried

4.THOUGHTS: CONTENT:About business and financial dependence

5.PERCEPTION: No perceptional abnormalities

6.COGNITION:

a.ORIENTATION:patient  is well oriented to place,person and time.

1. ATTENTION:Good

c.CONCENTRATION: Good

d.MEMORY:Immediate: 4/5

Recent: Good

Remote: Good

e.INTELLIGENCE:Good

f.Abstract Thinking:Good

g.Insight:Present

h.JUDGEMENT:Good

PROVISIONAL DIAGNOSIS: Non Organic Insomnia^{3 –}

Since the case is psychogenic and no physical painfull symptoms are involved.³

NUX VOMICA  covers 13 out of 14 symptoms with totality points 38

Prescription-NUX VOMICA 1M  HS

SL PACKETS -2 WEEKS

1^ST FOLLOW UP-patient came after 15 days with the quality of sleep much improved .He explained there is complete sensation of exhaustion,prostration after coitus along with lower backace since morning

Kali phos 6x  -(2-2-2) / week

Sl packets HS /30 days

2^nd FOLLOW UP- Patient quality of initiating sleep improved significant in the whole month only 2 days he was not able to  initiate or maintain sleep .no complaints of lower backace

Nux vomica 1M HS

SL PACKETS HS / 30 days

3^rd follow up- sleep quantity improved 75%

All generals good

SL Packets HS /30 Days

CONCLUSION: In cases of NON ORGANIC INSOMNIA good results can be obtained by our Homoeopathic medicine

REFRENCES:

1. Kaplan & Sadock’s .Synopsis of psychiatry,10^th edition,2013
2. Gelder,Andreasen,Lopez-Ibor jr,Geddes.New oxford textbook of Psychiatry 2 edition,2009
3. Diagnostic And Statistical Manual Of Mental Disorders 5 Edition
4. PATIL-Group Study in Homeopathic materia medica
5. SANKARAN-The soul of remedies
6. World health Organisation.International classification of Diseases ICD 10 Classification of mental &Behavioural disorders: Clinical Descriptions and Diagnostic Guidelines.World health Organisation Geneva;1993
7. Vithoulkas- Essence of Materia Medica, second edition; 2009

Dr Arun Kumar
MD-Part 1
Department of Psychiatry
Father Muller Homeopathic Medical College & Hospital,
Deralakatte, Mangalore-575018