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Lack of Sleep and Cardiac Problems

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What killed Ranjan Das and Lessons for Corporate India
A month ago, many of us heard about the sad demise of Ranjan Das from Bandra, Mumbai. Ranjan, just 42 years of age, was the CEO of SAP-Indian Subcontinent, the youngest CEO of an MNC in India. He was very active in sports, was a fitness freak and a marathon runner. It was common to see him run on Bandra's Carter Road. Just after Diwali, on 21st Oct, he returned home from his gym after a workout, collapsed with a massive heart attack and died. He is survived by his wife and two very young kids.

It was certainly a wake-up call for corporate India. However, it was even more disastrous for runners amongst us. Since Ranjan was an avid marathoner (in Feb 09, he ran Chennai Marathon at the same time some of us were running Pondicherry Marathon 180 km away), the question came as to why an exceptionally active, athletic person succumb to heart attack at 42 years of age.
Was it the stress?
A couple of you called me asking about the reasons. While Ranjan had mentioned that he faced a lot of stress, that is a common element in most of our lives. We used to think that by being fit, one can conquer the bad effects of stress. So I doubted if the cause was stress.
The Real Reason
However, everyone missed out a small line in the reports that Ranjan used to make do with 4-5 hours of sleep. This is an earlier interview of Ranjan on NDTV in the program 'Boss' Day Out':
Boss' Day Out: Ranjan Das of SAP India
Here he himself admits that he would love to get more sleep (and that he was not proud of his ability to manage without sleep, contrary to what others extolled).

The Evidence
Last week, I was working with a well-known cardiologist on the subject of ‘Heart Disease caused by Lack of Sleep’. While I cannot share the video nor the slides because of confidentiality reasons, I have distilled the key points below in the hope it will save some of our lives.
Some Excerpts:
· Short sleep duration (<5 or 5-6 hours) increased risk for high BP by 350% to 500% compared to those who slept longer than 6 hours per night. Paper published in 2009.
As you know, high BP kills.
· Young people (25-49 years of age) are twice as likely to get high BP if they sleep less. Paper published in 2006.
· Individuals who slept less than 5 hours a night had a 3-fold increased risk of heart attacks. Paper published in 1999.
· Complete and partial lack of sleep increased the blood concentrations of High sensitivity C-Reactive Protein (hs-cRP), the strongest predictor of heart attacks. Even after getting adequate sleep later, the levels stayed high!!
· Just one night of sleep loss increases very toxic substances in body such as Interleukin-6 (IL-6), Tumour Necrosis Factor-Alpha (TNF-alpha) and C-reactive protein (cRP). They increase risks of many medical conditions, including cancer, arthritis and heart disease. Paper published in 2004.
· Sleeping for <=5 hours per night leads to 39% increase in heart disease. Sleeping for <=6 hours per night leads to 18% increase in heart disease. Paper published in 2006.
Ideal Sleep
For lack of space, I cannot explain here the ideal sleep architecture. But in brief, sleep is composed of two stages: REM (Rapid Eye Movement) and non-REM. The former helps in mental consolidation while the latter helps in physical repair and rebuilding. During the night, you alternate between REM and non-REM stages 4-5 times.
The earlier part of sleep is mostly non-REM. During that period, your pituitary gland releases growth hormones that repair your body. The latter part of sleep is more and more REM type.
For you to be mentally alert during the day, the latter part of sleep is more important. No wonder when you wake up with an alarm clock after 5-6 hours of sleep, you are mentally irritable throughout the day (lack of REM sleep). And if you have slept for less than 5 hours, your body is in a complete physical mess (lack of non-REM sleep), you are tired throughout the day, moving like a zombie and your immunity is way down (I’ve been there, done that L)
Finally, as long-distance runners, you need an hour of extra sleep to repair the running related damage.
If you want to know if you are getting adequate sleep, take Epworth Sleepiness Test below.

Interpretation: Score of 0-9 is considered normal while 10 and above abnormal. Many a times, I have clocked 21 out the maximum possible 24, the only saving grace being the last situation, since I don’t like to drive (maybe, I should ask my driver to answer that line J)

In conclusion:

Barring stress control, Ranjan Das did everything right: eating proper food, exercising (marathoning!), maintaining proper weight. But he missed getting proper and adequate sleep, minimum 7 hours. In my opinion, that killed him.
If you are not getting enough sleep (7 hours), you are playing with fire, even if you have low stress.

I always took pride in my ability to work 50 hours at a stretch whenever the situation warranted. But I was so spooked after seeing the scientific evidence last week that since Saturday night, I ensure I do not even set the alarm clock under 7 hours. Now, that is a nice excuse to get some more sleep. J

Unfortunately, Ranjan Das is not alone when it comes to missing sleep. Many of us are doing exactly the same, perhaps out of ignorance. Please forward this mail/article to as many of your colleagues/friends as possible, especially those who might be short-changing their sleep. If we can save even one young life because of this email, I would be the happiest person on earth.
Madhur Kotharay
[email protected]

ps: Incidentally, just as human beings need 7 hours of sleep, you should know that cats need 15 hours of sleep and horses need 3 hours of it. So are you planning to be a cool cat or a dumb horse? J
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But dear Bala, people in this generation prefer to work in Night shifts conitiniouly and as per the IT sector, the boy who locked himself with a project returns home after 3 days hard work. The salary is more no doubt, but we are to loose something to gain few comforts.

i am 100% in agreement with this article.

i need minimum 8 hours of sleep a night and a total of about 60 hours a week. where i cut short in any night, my body demands that it be made up in a few days.

the long term effect of sleep deprivance can be fatal. i agree. sleep is the time for the body to repair itself from the ravages of modern living.

bringing over daytime tension to the night, affects not only the abilty to sleep, but also if achieved, its quality as well. i do not know how, but we cannot simply afford to carry over our work tensions to home to sleep time.

also, another warning for fitness buffs.

be very careful when you substitute proteins for food. i was told of potential kidney damage.

also, some advocate to drink minimum of 8 litres of water per day. it may result in a clean system, but i was told it kills your kidneys.

so, i would recommend caution before going to extremes.

i also believe tension causes stress, and stress kills.
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This is really an eye opener for all.

For the sake of extra bucks, risking one's life is bad and totally uncalled for.

I too need a sleep for 8 to 9 hours a day.

Doctors say, 'if you cannot afford to sleep long hours, at least lie down, close your eyes and be relaxed. You may listen to some 'soft and sweet music' by keeping the volume very low - just audible to you only.

Never brood on the mistakes committed by you or the injustice meted out to you (in your assessment) or the problems that lie ahead. Keep this space exclusively for yourself".

Sleep, Hunger and Motion at right time and at the right level indicate one's physical health that causes no worry to anyone.
I have always heard that 'hard work never killed anyone'. I know very high energy people who can not sleep beyond five hours a night. A lot of them are my contemporaries, in their sixties and seventies and doing well physically.

I suspect the lack of sleep for the person mentioned here is probably due to his physiology interacting badly with his personality - he seems to be an 'A' type personality. I am sure his body was giving out warning signs, that he probably dismissed or missed.

I do not think that there is a prescribed amount of sleep necessary for everyone. It can vary from as little as 4 hours to all the way to 9 hours, depending on one's physiology. I think the factor that kills is tension that causes hyper tension and if your genes are susceptible to heart attack, then you are at very high risk.

Learn to listen to your body's cries for help, as it always tries to warn you beforehand.

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@KRS.. In order to assess whether a person is having adequate sleep the author of this article has recommended Epworth Test.
Dear oneews Ji,

Yes, I am not contradicting the author's recommendations or conclusions. Mine is supplemental. I think that one knows when one is sleep deprived if one is attuned to one's body and the test will confirm that.

Just to share with everyone.Lack of sleep is a serious problem these days.
In malaysia where i stay many of my patients are also temple priest(brahmanas), who are displaying early symptoms of cardivascular disease, diabetes and high blood pressure.Invariably many of them have abdominal obesity and high body fat percentage( not neccasarily obese but a high fat to muscle ratio).
Many of them do not get enough sleep may be about 4-5 hours or even less because of working conditions in Malaysia.
None of them ever exercise, not even Yoga because of severe time constrain.
I always advise them to have time off to exercise and have more sleep but many say
its not possible.
I do not know how the condition is in India.
Diet also plays a very important role in determining Cardivascular Health.
Being vegetarian is not enough. Unknowingly many vegetarians consume a high carbhohydrate,low protein diet which accelerates the Triad of cardiovascular disease, diabetes and hypertension i had mentioned earlier.
Each meal should have a good portion of protein eg of protein sources: curds, sprouted mung beans,garbenzo beans(popular in india), soya milk, soya beans and paneer, a good power pack protein dish is mashed garbenzo beans with curds.
Protein increases the body metabolic rate which prevents fat deposition esp in the midsection.

Kindly read the following.

How are sleep and heart disease related?

by Charles W. Bryant
Cite This!

Please copy/paste the following text to properly cite this HowStuffWorks article:

Bryant, Charles W. "How are sleep and heart disease related?." 03 September 2008. HowStuffWorks.com. <http://health.howstuffworks.com/sleep-and-heart-disease.htm> 11 November 2009.

Inside this Article

  1. How are sleep and heart disease related?
  2. Effects of Sleep Deprivation on the Heart
  1. Lots More Information
  2. See all Sleep articles
Health Videos

Effects of Sleep Deprivation on the Heart

There's an old joke among doctors that the function of sleep is to cure sleepiness. Despite an abundance of research, we still aren't sure exactly why we sleep. But we know we need to. Recent studies indicate that too much or too little sleep can be a factor in developing heart disease, just like smoking and packing on the pounds.


A 10-year study performed by Harvard University tracked the sleep habits and health of more than 70,000 women between the ages of 45 and 65 that had no previous history of heart disease. In the end, 934 of these women suffered from coronary heart disease and 271 died from it. The researchers accounted for factors like age, weight and whether they smoked, then looked at the subjects' sleep patterns. Five percent of the women slept less than five hours per night. Those women were nearly 40 percent more likely to suffer from heart disease than women who slept an average of eight hours. Women who slept more than nine hours per night were 37 percent more likely to have heart trouble.
Previous studies have shown similar results for men. Short-term sleep deprivation is known to raise blood pressure and stress hormones, lower glucose tolerance and even lead to irregular heartbeats. All of these factors are precursors to coronary disease. Chronic sleep deprivation promotes weight gain and diabetes, both of which can send you to the emergency room grabbing your chest. Going without enough sleep also affects the functioning of the lining inside the blood vessels and can cause some low-grade inflammation that could lead to heart disease.
Sleep apnea is another problem. This is a condition that makes your airway temporarily collapse when you sleep, forcing you to wake up and resume breathing. This makes for fitful sleep at best. Research has shown that people with sleep apnea also show marked increases in their blood pressure over the years. They also have a higher level of sympathetic nervous system (SNS) action. The SNS controls the heart rate and the constriction of the blood vessels. If you don't have sleep apnea, shortly after you fall asleep, your blood pressure and SNS activity will slowly fall. This can't happen when you're waking up at regular intervals to resume breathing.
If you think you're in the clear because you're a young whipper-snapper, think again. Teens that sleep less than 6.5 hours per night are more than twice as likely to get high blood pressure [source: AHA]. When you consider that teens average roughly seven hours of sleep when they require nine, it's clear that kids need to put down that Guitar Hero axe, shut off the iPhone and catch some Zs.
Now for the good news. If you want to eliminate this factor from whether you develop heart disease, all you need to do is go beddy-bye for eight hours. There are other factors, like what you eat and how much you exercise, but this one is taken care of by doing something most people love to do -- sleep. Doctors even believe that 30-minute naps a few times a week can improve your health, and many forward-thinking companies are outfitting their buildings with nap rooms.
If you have trouble sleeping, make your bedroom a haven for slumber. Paint your walls in cool blues. Ditch the TV and the laptop. Try to sleep eight hours each night -- you're doing your heart a big favor
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Thanks for the medical advice, Doctor.

I wish to add these.

Stress in modern world, especially in urban settings, is said to be the cause for highest number of deaths (by cardiac arrest and suicides), next only to accidents.

Coping stress is not everybody's cup of tea. Even well educated persons find it hard to find right kind of solutions. We must remember the adage "Prevention is better than cure". The Tamil equivalent is "Varum mun kaappom".

Youth of today over-estimate their physical strength and tolerance/immunity level.

I have these specific suggestions.

1. Apart from regulating food habits, taking rest for 5 minutes, after every 1 hour of
strenuous work will have salutary effects.

2. Without sitting at one place, in one posture continuously for several hours, learn
to walk within the office every 30 minutes.

3. Instead of depending on menial staff, for bringing some stationery or water or a
file, why don't you go and get it yourself. (It is a good exercise you would be
doing, without your being aware of it).

4. Appropriate illumination, preferably natural lighting, good ventilation (again
preferably natural ventilation), right seating arrangement (ergonomically designed,
varying with different persons, their nature of work etc.) and hygienic environment
inside the office etc. are very essential. By hygienic environment I mean
cleanliness, dust-free, noise-free environment, safe drinking water and clean

5. Don't wear your official hat always. Once in a while, free yourself from office work
and converse with your colleagues, not just peers, to share some personal
thoughts and experiences.

6. Laugh aloud, because humour is one of the best medicines for stress.

7. Change your routine, off and on. For example, the mode of transport, helping the
kids in their studies, dropping them at their school/college, helping your wife in her
daily chores etc.

8. Take your entire family for an outing, at least once a month. (Avoid crowded
places like cinema theatres).

9. Visit some far off place, suiting your budget, at least once a year, with your

10. Most important:

Be honest and simple. You need not fear anyone.

11. Last but the least, if something happens despite all these precautions, never
panic. It's just another phase of (this) life. That's all.
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Dear Dr,

Any information regarding after lunch nap. will that time counted? Is it ok to doze off after lunch for half an hour or one hour? what is the ideal?

do you mean immediately after lunch?
if you mean so, i wont recommend it because lying down immediately after meals can cause and aggrevate the reflux of stomach contents into the esophagus causing Gastro Esophagal Reflux Disease(GERD) commonly known as Heart Burn.
i would recommend at least wait for an 1/12 hours after lunch.

If i am not wrong sleeping and bathing immediately after a meal slows down the "digestive fire" in our body according to Ayurveda. Hence all the more its not very advisable to sleep right after meals.
Opinions may differ in this as main stream medicine does not believe in "digestive fire"

Aham vaishvanaro bhutva
praaninam deham aashritah
praapaana samaayuktah
pacaamy annam catur vidham
Dr.Renuka ji,

What an extensive and elaborate explanations you have given...Thank you very much.

If not mistaken, I would like to seek your personal guidance.

Dr, basically I am very much health conscious and never leave any minor physical issues un-attended...

But after coming to Dubai on work, I could not care much of my physiques for the past 2 years due time constraint and being totally self-depended for everything that one does and needs in this routine...

Every meal, tea and any other edible are all from Hotel only. So I eat (generally all) just for a name sake. That too every day it would be untimely.

I be always on my chair from the morning till the day end in front of the computer. The health seems to be deteriorating.

One fine day, I seriously thought about this disgusting life style and got much worried about my health. On that day I strongly determined to start working out in a GYM to have good blood circulations, appetite and general physical fitness.

I started working out in a GYM since April this year. But this as well found to be problematic because of lack of sleep. But since I started physically feeling better I am continuing till today.

Dr, I wake up in the morning at 3:30 am, do my prayers for about half an hour and leave my room at 5:15 am. I reach my GYM at 6:15 am and work out for 2 hours.

From 9 am I start working in my office. Being one of Arabic Group of companies, we have afternoon break from 2pm to 5pm. During this time after my lunch I sleep in our exclusive room for about 1 and half hours. I leave office by 8 pm, reach my place of residence by 9.30pm, have my food and sleep by 11 am. Having slept in the afternoon I could really get into sleep by 11:30 pm only.

This way I could sleep only for 4 hours in the night and 1 and a half hour in the afternoon. Over all I could sleep only for 5 and half hours in a day.

In order to substitute rubbish food intake from the hotel, I used to have the following as my break fast every day after my work out in the GYM.

I generally prefer to take heavy breakfast...

- 500 ml of cow milk (fat free). I consume 250 ml just as plain milk and 250 ml hot milk with a pinch of SAFFARON (keeping it soaked for 15 minutes)

- 300 ml of Soya Milk

- 100 g of Corn Flakes with 250 ml of cow milk

- 100 g of Cashew OR Almond OR Pistachio OR Dried Graps

For the Lunch - A cup of Curd Rise / Sambar Rice

For the Night - 5 small Rotis and Bhaji

I am having the above for the past 9 months.

I kindly request your opinion on my sleeping and eating habits as detailed above that would help me to correct myself where ever required...

Your valuable advice and guidance would be highly appreciated…

Thanking you in advance...



dear Ravi ji,
you havent told me your height and weight for me to calculate your Body Mass Index(BMI) to determine your overall health status(BMI is only a rough guide as it does not give an accurate assesment of ones body fat %)
People of South Asian Origin eg Indians have a higher genetic risk of developing Metabolic Syndrome(the Triad i had mentioned in my earlier post) and generally carry more weight around the midsection which can increase the risk for a heart attack.

Your lifestyle is rather hectic i see but nevertheless its commendable that you never miss your prayers.
You work out in the gym for 2 hours thats ok but seems a bit long for daily basis.
A good workout should always include at least 30 mins of cardiovascular work out.walking on threadmill, stationary bike, rowing machine, stairmaster etc.
always do cardio first( to increase blood supply to muscle) before hitting the weights, even though many men will do the opposite.
in cardio exercise make sure your heart rate(pulse rate) is in the the target heart rate zone that is 60-70% of (220 minus your age) anything lower than that will burn only glycogen and you will feel very hungry after workout. higher then that will cause burning of precious muscle tissue and decrease your metabolism.

target heart rate work outs will initially burn glycogen and then move into fat burning zone and you wont feel hungry after workout.

keep yourself well hydrated. drink water throughout work out whether thirsty or not.

keep away from isotonic drinks post work out as they are not too needed if you are working out in an aircond gym.

with regard to weights: breathing technique is most important while lifting weights.
Never ever hold your breath or inhale while lifting weights as this increases intrabdominal pressure and increases risk for hernias in males.
always get to the point when your lungs have exhaled but still a little air left in it and then lift your weights.

food: your breakfast seems fairly good.but comercial corn flakes have high content of refined sugar. you can also take oats with milk.
you can also blend 2 bananas with low fat milk and add a little cocoa powder(after diluting it with warm water) and have it as a post work out drink
since you are working out regularly and lead a stressful lifestyle please take a vit B & C supplements.

your lunch of curd rice/sambar is ok but try to eat thicker dhall, paneer, and garbenzo beans for a higher protein meal as your work out rather long hours.
please take fruits and green leafy vegetables.
for dinner make sure there is protein along with your bhaji/capatis
try not to take too much ghee/oil along with your capatis. if you can get tofu at dubai have it once in a while.

you are totally lacking in sleep my dear Ravi ji, that i can hardly help you. you should try at least 6 hours minimum.
you have to fit in an extra 1/2 hour somewhere. have a light lunch if you plan to sleep right way after meals. make it a higher protein and very minimal carbhohydrate meal so that your blood sugar level wont rise too high after a meal as this causes fat deposition when you are asleep.

hope my explanation is clear enough.
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Dear Dr Renuka Ji,

Thank you very much for your reply, and the posts are very informative, i keep reading.. thanks.

Dr.Renuka ji,

Thank you so much for your detailed reply....

The time that you have taken to read my personal request and the efforts with which you have pin pointed every requirements for me are all highly appreciative.

I thank you whole heartedly for your kind gesture to help me with required directions.

By the way as you have indicated, I forgot to specify my age and weight.

By that calculation, I think I am over weight...Because my age is - 33 years; height - 5.6 & weight - 76.4 [this is quit disgusting for me. Because before started working out I was only 73.5. But now Iam weighing 76.4 though I became slim and good structured without belly]


Dear Shri. Ravi,

Just out of curiosity, why do you wake up at 3.30 am? Is it because you want to wake up in the brahmamuhurtham time? How on earth do you manage to sleep just for 4 and half hours in the night? Gym is good but may be you can try walking/running outside Zabeel or Safa park if you drive. There is a rubberized track which does not affect the back. Since you get up so early you will not have traffic trouble reaching these places.

I find the fresh air much better than the stale conditioned air we keep breathing. I work in Dubai and probably we will meet sometime soon.

dont worry, muscle tissue weighs 3 times more than fat and occupies less storage space hence one may look trim and with flater abs.
you could have lost fat and gained muscle.
just be consistent in your work out.
Dear Shri. Ravi,

Just out of curiosity, why do you wake up at 3.30 am? Is it because you want to wake up in the brahmamuhurtham time? How on earth do you manage to sleep just for 4 and half hours in the night? Gym is good but may be you can try walking/running outside Zabeel or Safa park if you drive. There is a rubberized track which does not affect the back. Since you get up so early you will not have traffic trouble reaching these places.

I find the fresh air much better than the stale conditioned air we keep breathing. I work in Dubai and probably we will meet sometime soon.


Sri Anand ji,

Your suggestion is really good....

I have seen lots of girl, boys, aunties, uncles running on the rubberized track during winter evening as well.

Being a bachelor, I stay in a sharing bachelor accommodation where chances of flexibility are ruled out. The exclusive bachelor’s G+2 apartment does not have exclusive Car Park. And as you know finding a space for Car parking is the toughest job in Dubai, I could never feel to think about obtaining a license and own a car. I rejected my companies offer of 50% License fee re-imbursement and a Car to commute.

Thus, for me it's practical only by way leave my room early in the morning and go to GYM near to my office, change my cloth, work out, take bath in the GYM, and get into my office before 9am.

This has offered me to take the benefit of Brahma Muhurtham unintentionally

Yeah, I too believe so…..We will meet sometime soon

By the way, I am also curious to know as whether we Tamil Brahmin in Dubai have any sort of gathering somewhere to involve in Bhajans and any other spiritual/cultural activities? Like Sindhi Memorial Hall in Meena Bazaar, Bur Dubai, where there will be such religious activities are carried out and lunch provided on every Friday. I stay in Bur Dubai but could never make it out on any Fridays…Because that is the day when we wake up not before 10 am.



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the following site give some remedies for good sleep
Article: Insomnia Treatment with Ayurvedic and Home Remedies - by Tom alter

v r following western concept of work culture--mostly good but it too needs lot of introspection often
1.Organization and Occidental culture of West-- I found many westerners r workaholics ,must be due to less of serotonin from wheat eating and NV food--this gives less sleep,so many easily adopt to working for long hours 10-15 is common
2. in Org ego often dominates--towards subordinates '' whenever one finishes work ,he is given another work and so on--making him unsatisfied [work is not programmed but is told at last moment i.e., while leaving the office,many r told to work another and complete it --this way ,everyone is unsatisfied
3.so Boss or higher officer is putting pressure that is unwarranted,to his subordinate always unsatisfied so that he is under control
4.Excessive and illegitimate profits for Corporates is driving many to work more than usual

Oriental work and culture--v take rice as staple food,this has serotonin that gives good sleep and intelligence too--Westerners do not like Asians sleeping too long often after lunch [light nap can reduce unwanted sleepiness,can help to increase in productivity too--followed in Gulf region during summer? ]Westerners may laugh at this suggestions

1. it is difficult to work during 3.00-6.00/7.00 hours even if he had sleep
2. most of accidents during early mornings 'cause of lack of sleep[fresh breeze induces sleep]
3.disturbing schedule of sleep leads to unsatisfied work,over a period of time it can lead to heart problems
4. flexy time is very important for satisfaction of work,one may even work more than usual if this option is given
5.last minute --unwarranted schedule and making one to rush for work--is most dangerous one --a cardiac weapon
6.Many Indians hate Night duty [time for sleep]--it can b a option than a rule
7.Beyond certain gain in money there is no much value to it in life?
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dear Sharma ji,
i really cannot shower you with any answers right now, i do not have sufficient clouds of knowledge at present. anyhow interesting enough for me to look for answers.
Sleep time and period is only by habit. Infants sleep within short gaps.Strong light and noise disturbs sleep. People working in night shift can have a good sleep in day time and get totally refreshed as if from night sleep , if they sleep in a place conducive to that( silent, dark, and comfortably warm/cool).I had personal experience of about 4 years.

Tension of mind in the pre sleep period disturbs sleep.

In childhood I was taught to pray Nidradevi ,before going to sleep,for getting good sleep without "dusswapnas".

I the present day one can practice self hypnosis to instruct body and mind to relax to a specified period.
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