RESEARCH QUESTION:
What is the difference in Smriti (Working memory) of shift workers following different sleep patterns to the normal shift workers (day shift workers) following normal sleep patterns?
NULL HYPOTHESIS (H0): There is no difference in Smriti (Working memory) of shift workers following different sleep patterns to the normal shift workers (day shift workers) following normal sleep patterns.
ALTERNATE HYPOTHESIS (H1): There is difference in Smriti (Working memory) of shift workers following different sleep patterns to the normal shift workers (day shift workers) following normal sleep patterns.
INTRODUCTION:
यदा तॠमनसि कà¥à¤²à¤¾à¤¨à¥à¤¤à¥‡ कमाातà¥à¤®à¤¾à¤¨à¤ƒ कà¥à¤²à¤®à¤¾à¤¨à¥à¤µà¤¿à¤¤à¤¾à¤ƒ | सिषयेà¤à¥à¤¯à¥‹ सनितानà¥à¤¤à¥‡ तदा सà¥à¤µà¤¸à¤¿à¤¸à¤¤ मानिः||1 ( च. िू. २१/३५)
Nidra is one of the three Upstambha of life. It is as important as that of Ahara and Brahmcharya. It is said that when Mana gets exhausted due to excessive work and Indriyas also gets rid of their work due to tiredness, then one sleeps.
अकालेऽसतपà¥à¤°à¤¿à¤™à¥à¤—ाचà¥à¤š न च सनदà¥à¤°à¤¾ सनषेसिता | िà¥à¤–ायà¥à¤·à¥€ िराकॠयाातॠकालरासिररिािरा ||2 (च. िू. २१/३à¥)
Also it is said that Nidra taken out of time or in excessive amount or not taken properly is as harmful as Kalratri and takes happiness away. In Ayurveda text six types of Nidra are given in which ratriswabhava nidra is the nidra taken at night and it is also consider as physiological .other five types are due to some pathology.3
रािौ जागरणं रूकà¥à¤·à¤‚ ……….. I4 (च. िू. २१/५०)
When this Ratriswabhav Nidra is hampered due to any reason and person wakes up throughout night it causes vata dosh vruddhi. When vata dosha vruddhi occurs it affects Smriti.
सà¥à¤®à¥ƒà¤¸à¤¤à¤¬à¥à¤¨à¥à¤µà¤¿à¤ªà¥à¤°à¤®à¥‹à¤¹à¤¶à¥à¤šâ€¦â€¦â€¦â€¦.II5 (च .िू .२१/४८)
Also Divaswpn (day sleep) causes Smritibuddhimohasch. In Sushrut Samhita lakshan of Nidra taken in Samyaka kala are mentioned as
पà¥à¤·à¥à¤Ÿà¤¿ वरà¥à¤£ बलोतà¥à¤¸à¤¾à¤¹à¤®à¤·à¥à¤Ÿà¤¿ दीपà¥à¤¤à¤¿à¤®à¤¤à¤‚षà¥à¤Ÿà¤¿à¤¤à¤¾à¤®à¥ । करोषà¥à¤Ÿà¤¤ धातॠसामà¥à¤¯à¤‚ च षà¥à¤Ÿà¤¿à¤¿à¤¾ काले षà¥à¤Ÿà¤¿à¤·à¥‡à¤·à¥à¤Ÿà¤µà¤¤à¤¾ ।।6 (िà¥. सच . २४ /८८ )
Nidra taken at proper time causes nutrition of body, increment of complexion, strength and joy. It increases agni, and causes proper balance of all the dhatus. Smriti Vibhramsha is the state in which the memory is altered from its normalcy; this means either reduced memory or selective memory or total loss of memory. In various classics, scattered knowledge of Smritihrasa can be concluded as: Mana when hindered by Vata pradhana Smriti Vibhramsha tridosha prakopa, leads to Rajo and Tamo Guna Vriddhi and causing Avarana of Manovaha Srotasa (occlusion in channels of psychic activities) thereby finally leading to Dhi, Dhriti and Smriti Vibhramsa7. In modern science, Sleep quality is the measurement of how well you’re sleeping—in other words, whether your sleep is restful and restorative. Four items are generally assessed to measure sleep quality:8 Sleep latency: This is a measurement of how long it takes you to fall asleep. Drifting off within 30 minutes or less after the time you go to bed suggests that the quality of your sleep is good. Sleep waking: This measures how often you wake up during the night. Frequent wakefulness at night can disrupt your sleep cycle and reduce your sleep quality. Waking up once or not at all suggests that your sleep quality is good. Wakefulness: This measurement refers to how many minutes you spend awake during the night after you first go to sleep. People with good sleep quality have 20 minutes or less of wakefulness during the night. Sleep efficiency: The amount of time you spend actually sleeping while in bed is known as sleep efficiency. This measurement should ideally be 85 percent or more for optimal health benefits. Working memory9 is a cognitive system with a limited capacity that can hold information temporarily. It is important for reasoning and the guidance of decision-making and behaviour. Working memory is often used synonymously with short-term memory, but some theorists consider the two forms of memory distinct, assuming that working memory allows for the manipulation of stored information, whereas short-term memory only refers to the short-term storage of information. Working memory is a theoretical concept central to cognitive psychology, neuropsychology, and neuroscience.
NEED OF THE STUDY:
• In the description of Nidra, Ratriswabhav Nidra is naturally occurring as a physiological process, others are due to some pathology • As per Ayurveda Ratrijagaran causes Vata dosha vriddhi and Rukshta in the body. Also, it is said that when Vata vriddhi occurs it affects the Smriti of the individual. • “Currently more than 55 million people have dementia worldwide, over 60% of whom live in low-and middle-income countries. Every year, there are nearly 10 million new casesâ€.(WHO, March 2023) • In Ayurveda Nidra and Smriti are considered to be closely associated but the evidence for the same is less. This study is an approach to find out the association of Nidra and Smriti, to fill the gap between concepts. • It is needed to generate the evidence for evaluation of the association of Prakriti with Nidra and Smriti which has been mentioned in classical Ayurvedic literature.
LITERATURE REVIEW:
CLASSICAL REVIEW: 1. In Charaka Samhita sutra sthan ekadashadyaya Acharya Charaka mentioned Nidra in Trayaupstambh and it should be practice with caution. Also Nidra is one of the Adharneeya Vega. Detailed description about Nidra is given in Charak sutra ekvinshati adyaya asthauninditiya adhyaya. 2. In Sushrut Samhita, Nidra is mentioned as one of the five swabhavika roga.In Sushrut Chikitsa 24 properties of kala nidra sevan are given. 3. Acharya Vagbhatt also refer Nidra as upstambh and adharneeya Vega. In short all the acharyas mentioned nidra as an important factor for life and its contribution in health. Also Ratrijagaran and Divaswapa are prohibited. Smriti Vibhramsha is the state in which the memory is altered from its normalcy; this means either reduced memory or selective memory or total loss of memory. In various classics, scattered knowledge of Smritihrasa can be concluded as: Mana when hindered by Vata pradhana Smriti Vibhramsha tridosha prakopa, leads to Rajo and Tamo Guna Vriddhi and causing Avarana of Manovaha Srotasa (occlusion in channels of psychic activities) thereby finally leading to Dhi, Dhriti and Smriti Vibhramsa.
CONTEMPORARY REVIEW: Sleep is a physiological process by which bodily functions are periodically rested. During sleep, consciousness and power of will are partially or completely suspended and bodily activity generally is greatly reduced. Sleep differs from alert wakefulness by loss of critical reactivity to events in the external environment, therefore, subject can be aroused by sensory stimulation. Sleep requirement: 1. Newborn: 18 to 20 hrs 2. Growing children: 12 to 14 hrs 3. Adults: 7 to 9 hrs 4. Old persons: 5 to 7 hrs Working memory (WM) is a cognitive construct that refers to the process of short-term storage and management of information. Although it is often used as a synonym of shortterm memory (STM), WM is frequently used to convey an additional emphasis on the active manipulation of buffered information. In contrast, STM refers to information storage without any type of manipulation and is, in fact, a key underlying process of WM. It has often been connected or related to intelligence, information processing, executive function, comprehension, problem-solving, and learning, in people ranging from infancy to old age.
PREVIOUS WORK DONE:
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S.NO.
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TITLE OF
ARTICLE
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JOURNA
L
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YEAR OF
PUBLICA
TION
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AUTHOR
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SUMMARY
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1.
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Ratrijagarana
night wakefulness and its impact on Manasika Bhava mental characteristics
among industrial workers: A descriptive crosssectional study10
|
JAIMS
|
2021
|
Elgeena
Varghese et al
|
A substantial change in Mana (non-distracted mind),
Chinta(anxiety/worry),
Dhairyam (courage),
Harsha (joy), Veeryam (energy), Shraddha (desire), Medha
(intelligence),Avasthaana
(stability of mind), Vignyaana
(knowledge), Sanjna
(recognition), and Smriti (memory).
|
|
2.
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RATRIJA
GARANA
(SLEEP
DEPRIVA
TION): A
MENACE
FOR
LIFESTY
LE
DISORDE
RS—A
REVIEW
11
|
IAMJ
|
2023
|
Thanusree N
Nair
|
To prevent this sort of disease due to sleep deprivation,
as per Acharya Charaka, those who are awakened during the night hours due to
their work schedule the next day before the intake of food should sleep half
of the awakened hours.
|
|
3.
|
Disturbance of the Circadian
System in Shift Work and
Its Health
Impact12
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PMC
|
30 dec,
2021
|
Diane B.
Boivin, Philippe Boudreau,
and Anastasi
Kosmadopoulos
|
Shift
work leads to acute and chronic disturbances of sleep and alertness and an
increased risk of fatigue-related incidents and accidents
|
|
4.
|
Lack of
Sleep May
Increase
Dementia
Risk13
|
NIH
|
14may
,2021
|
-
|
Analysis
of the data showed that people in their 50s and 60s who got 6 hours of sleep
or less were at increased risk of developing dementia later. Further research is needed to
confirm this connection and understand the underlying reasons.
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5.
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The effects of three
consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing
performance in day and night shift nurses: A quasiexperimental
study14
|
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November
2021
|
Lois James , Nat haniel
ElkinsBrown , Marian Wilson , Stephe n
M. James ,
Eliza beth Dotson , C harles
D. Edwards , La ura
Winterstee n-
Arleth ,
Kevin St evens , Patricia Butterfield
|
Nurses maintained their levels of performance for all domains
after three consecutive shifts. Individual differences in predicted cognitive
effectiveness could account for variation in performance by shift type for
Communication skills but for no other domain of performance.
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OBJECTIVES OF THE RESEARCH:
PRIMARY OBJECTIVE: 1. To assess the impact of Nidra (Sleep quality) on Smriti (Working memory) of individuals working in different shifts.
SECONDARY OBJECTIVES: 1. To assess the association of Deha Prakriti with Nidra (Sleep quality) and Smriti (working memory) of individuals working in different shifts.
MATERIALS AND METHODS:
Study Setting:- Delhi NCR Study type:- Retrospective, Analytical cross sectional study Population:- Shift workers (Day & Day-Night shift) Grouping:- Two arm study Group A: Day shift workers (working at the time for a minimum of 8 hours from atleast past six months) Group B: Day-Night shift workers (working at alternate day-night shift minimum 8 hours for 15-30 days/month from atleast past six months) Sample size – 100 in each group
SAMPLE SIZE CALCULATION: Since we wish to know if work related shifts causes loss in memory scale, so we will come to compare day shift workers and day-night shift workers for their memory status. Here day shift workers means adults regularly working in day time & others means day-night shift workers. Thus day-night shift workers may be treated as inference group. Assuming that 20% point’s reduction may results due to shift workers sleep patterns.
The calculated p value is 93 per group, assuming alpha 0.5, power 80% two sided test assuming 10% dropout 102
Inclusion Criteria: • Apparently healthy individuals of the age group 25-45 years irrespective of gender, caste, and religion. Participants should be Literate. • Individuals, willing to participate. • Group A: Day shift workers (working in day time for a minimum of 8 hours for at least the past six months) • Group B: Day-Night shift workers (working at alternate day-night shift minimum 8 hours for 15-30 days/month from at least the past six months
Exclusion Criteria: Individuals having a history of any head injury, head surgery • Individuals having a history of any major medical illness (HTN, DM, Parkinson’s disease, Alzheimer’s disease, etc.) • Individuals consuming any kind of medications, narcotics, etc. to induce sleep • Individuals taking any medication to enhance memory. • Individuals having drug and addiction (smoking) history. • Pregnant and lactating mothers.
ASSESSMENT CRITERIA: • Swasthya assessment scale (CSIR-IGIB/CCRAS) (Annexure 1) • Prakriti pariksha using CCRAS Prakriti assessment Scale. • Sleep quality assessment tool (Pittsburg Sleep quality Index).(Annexure2) • PGI memory scale.(Annexure3) • Lab investigation (for screening purpose) - CBC, Blood sugar, LFT, KFT, Thyroid profile, Lipid profile. • Melatonin hormone test (in selected participants, if feasible )
METHOD OF DATA COLLECTION: • The data of the selected participants (those who comply with the inclusion criteria and willing to take part in the study) will be collected. • The selected participants shall undergo the series of events which include informed consent about the study, their demographic details, a detailed history will be taken as per the requirements of the study.
METHODOLOGY: All involved procedures will be explained to the participants and written consent will be taken. A. Swasthya assessment & Lab investigations: • Participant’s health will be assessed with the help of Swasthya assessment scale. • Questions given in the scale will be asked and responses will be noted on the sheet. • Assessment will be done on the basis of scoring & lab investigations. Apparently healthy individuals will be screened and enrolled after fulfilling the inclusion criteria for the next step of study. B. Prakriti Parikshan • Enrolled participants will be proceeded with assessment of Prakriti with the help of CCRAS prakriti assessment scale. C. Sleep quality assessment: • Sleep quality will be checked with the help of PSQI • Responses will be noted on the sheet • Scoring will be done and participants will proceed for the next steps. D. Memory assessment Test: • Participants will be explained the SOP (Annexure 1) of the PGI memory assessment scale before starting the test. • Test will be done and responses will be noted. • Interpretations will be done and conclusion will be noted.
END POINTS: Primary end point – An association between Nidra and Smriti working memory will be obtained. Secondary end point – 1. Corelation between nidra and deha prakriti will be established. 2. Variation in working memory scale in relation with deha prakriti will be assessed
FLOW CHART OF OBSERVATIONAL STUDY Individuals will be screened and participants will be enrolled after taking written consent of the participants. Swasthya assessment will be done using IGIB/CCRAS swasthya assessment scale & lab investigation will be done. Apparently healthy participants will get divided in group A and group B as per the inclusion criteria. Prakriti assessment will be done by using CCRAS Prakriti assessment scale. Sleep quality of the participants of both the groups will be assessed by using PSQI Memory assessment of both the groups will be done using PGI memory scale Data collected from every tool will be statistically analyzed, discussion will be done, conclusion will be drawn
STATISTICAL METHOD FOR ANALYSIS: â‘ The generated data will be presented in the form of Frequency distribution, Bar diagrams wherever applicable and Chi-Square test will be used to compare between groups. â‘ The data generated in the observational study will be analyzed to compare proportion memory loss by using Z-TEST and other suitable tests will be used as per need. â‘ SPSS (Statistical Package for the Social Sciences) version 26 of programme will be used. â‘ Data will be stored in password protected computer and at the end of the study all the data will be handed over to the department.
ACCESS TO DATA AND CONFIDENTIALITY Data confidentiality will be maintained and Primary data will be preserved in the concerned Department for a period of 5 years.
ETHICS COMMITTEE CLEARANCE • The study will be started only after getting clearance from Institutional Ethics Committee, AIIA, New Delhi. • The present study will be carried out after taking the written consent from the Study Participants. • The CTRI Registration will be done.
EXPECTED OUTCOME - Decrease in working memory score will be obtained in disturbed sleep pattern individuals.
FINANCIAL SUPPORT PGI memory scale- 5,000 Melatonin kit- 40,000 Lab investigations- 180,000 (waived off by institute for research purpose) Transport expenses- 30,000 Miscellaneous – 2,000 TOTAL- 257,000
This study will be completed within the prescribed financial limit for the work. However, if more finance is required, the request will be made for due permission and approval of extra budget to the concerned authority AIIA, in due course of research work |