Abstract

Insomnia, defined as the persistent difficulty in initiating or maintaining sleep, is increasingly recognized as a major public health problem worldwide. Beyond its immediate effects on quality of life, chronic insomnia has been associated with long-term consequences such as increased risk of Alzheimer’s disease (AD), vascular dementia (VD), cardiovascular disorders, and accelerated aging. This article explores the role of Thai Traditional Medicine (TTM) in the management of insomnia, specifically focusing on classical herbal formulations, massage therapy, and lifestyle principles. Evidence from modern biomedical research is integrated to demonstrate how insomnia contributes to neurodegenerative processes, and how integrative approaches may reduce the burden of disease.

Introduction

Insomnia has been classified as one of the most prevalent sleep disorders globally, with studies indicating that up to 30% of the adult population experiences chronic sleep difficulties (Morin & Benca, 2012). From the perspective of Western medicine, insufficient sleep is strongly associated with impaired clearance of amyloid-beta (Aβ) proteins via the glymphatic system, particularly during slow-wave sleep (SWS) (Xie et al., 2013). The failure to clear these neurotoxic proteins contributes to the pathogenesis of Alzheimer’s disease.

Recent meta-analyses confirm that insomnia increases the risk of all-cause dementia by 36%, with significantly higher risks for both Alzheimer’s disease (OR 1.52) and vascular dementia (OR 2.10) (Zhou et al., 2025). Moreover, insomnia has been linked to premature aging, impaired immune responses, and metabolic disorders such as diabetes and hypertension (Irwin, 2015).

In Thailand, the Department of Thai Traditional and Alternative Medicine (DTAM) has emphasized the importance of TTM in addressing insomnia, offering culturally rooted interventions that combine herbal medicine, massage therapy, and lifestyle modification.

Thai Traditional Medicine Approaches

1. Classical Herbal Formulations

DTAM recommends two traditional formulations for the management of insomnia:

• Ya Hom Thep Chit (ยาหอมเทพจิตร)
  
  

  • Major component: Jasminum sambac (jasmine flowers).
    
    

  • Pharmacological actions: Cardiotonic, mood-stabilizing, headache relief, and induction of calmness through volatile essential oils.
    
    

  • Clinical effect: Promotes relaxation and facilitates restorative sleep.
    
    

• Ya Suk Saiyas (ยาศุขไสยาศน์)
  
  

  • Actions: Induces sleep, improves appetite, and enhances overall sleep quality.
    
    

  • Clinical relevance: Particularly beneficial for patients suffering from chronic insomnia with comorbid fatigue or anorexia.
    
    

2. Key Medicinal Herbs for Sleep and Stress Reduction

• Cassia siamea (Khilek, ขี้เหล็ก): Traditionally used for insomnia, containing barakol, a natural sedative.
  
  

• Centella asiatica (Bua Bok, ใบบัวบก): Neurotonic properties; reduces anxiety, enhances GABAergic activity.
  
  

• Momordica charantia (Mara Khino, มะระขี้นก): Bitter and cooling; alleviates systemic heat and improves sleep.
  
  

Recommended dietary integration includes khilek curry, neem with sweet fish sauce, and bitter melon stir-fried with eggs. Herbal drinks such as Centella asiatica juice are also advised.

3. Thai Massage Therapy

Traditional Thai massage has been shown to:

• Relieve musculoskeletal tension
  
  

• Reduce cortisol levels
  
  

• Improve peripheral blood circulation
  
  

• Enhance parasympathetic activity leading to improved sleep quality (Buttagat et al., 2011).
  
  

4. Lifestyle Modification: Dhammanamai Principles

TTM emphasizes the Three Health Principles (ธรรมานามัย):

1. Kayānāmai (Healthy body) – Maintaining physical well-being through exercise and proper diet.
   
   

2. Cittānāmai (Healthy mind) – Promoting mental stability through meditation and mindfulness.
   
   

3. Chivitānāmai (Healthy behavior) – Adopting ethical, balanced daily routines.
   
   

Western Medical Perspective on Insomnia Treatment

Conventional approaches include pharmacological treatments such as benzodiazepines and non-benzodiazepine hypnotics. However, these agents are associated with increased risks of falls, disability, and cognitive impairment in the elderly (Glass et al., 2005). Cognitive Behavioral Therapy for Insomnia (CBT-I) remains the gold standard non-pharmacological treatment. Nevertheless, access to trained therapists remains limited.

The integration of Thai herbal medicine and massage therapy with CBT-I offers a promising pathway for safe and effective management of insomnia, particularly in elderly populations at risk of dementia.

Discussion

The convergence of modern biomedical research and Thai Traditional Medicine presents a strong case for integrative management of insomnia. While Western medicine provides mechanistic explanations linking poor sleep with amyloid accumulation and neurodegeneration, TTM provides accessible and culturally accepted therapeutic tools that can be used long-term with minimal side effects.

By combining evidence-based herbal formulations, manual therapy, and lifestyle alignment, patients may achieve both symptomatic relief and long-term protection against neurodegenerative processes.

Conclusion

Insomnia is not a benign condition; it is a significant risk factor for Alzheimer’s disease, vascular dementia, premature aging, and systemic illnesses. Both modern scientific evidence and traditional Thai medical wisdom highlight the importance of early intervention. Herbal formulations such as Ya Hom Thep Chit and Ya Suk Saiyas, along with stress-reducing herbs, Thai massage, and lifestyle regulation, provide safe and effective options.

For individuals suffering from insomnia, free consultation is available with Dr. Jessica Sarikanont Ngamtin (“Dr. Jessica”), who offers professional advice as a contribution to Thai society without charge.

References

• Buttagat, V., Eungpinichpong, W., Chatchawan, U., & Kharmwan, S. (2011). The immediate effects of traditional Thai massage on heart rate variability and stress-related parameters in patients with back pain. Journal of Bodywork and Movement Therapies, 15(1), 15–23. https://doi.org/10.1016/j.jbmt.2009.06.006
  
  

• Department of Thai Traditional and Alternative Medicine (DTAM). (2024). World Sleep Day: Thai wisdom for insomnia relief. Ministry of Public Health, Thailand.
  
  

• Glass, J., Lanctôt, K. L., Herrmann, N., Sproule, B. A., & Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331(7526), 1169. https://doi.org/10.1136/bmj.38623.768588.47
  
  

• Irwin, M. R. (2015). Why sleep is important for health: A psychoneuroimmunology perspective. Annual Review of Psychology, 66, 143–172. https://doi.org/10.1146/annurev-psych-010213-115205
  
  

• Morin, C. M., & Benca, R. (2012). Chronic insomnia. The Lancet, 379(9821), 1129–1141. https://doi.org/10.1016/S0140-6736(11)60750-2
  
  

• Xie, L., Kang, H., Xu, Q., Chen, M. J., Liao, Y., Thiyagarajan, M., ... & Nedergaard, M. (2013). Sleep drives metabolite clearance from the adult brain. Science, 342(6156), 373–377. https://doi.org/10.1126/science.1241224
  
  

• Zhou, R., Liang, X., Deng, H., Li, X., Yang, J., Liu, L., & Zhang, H. (2025). Insomnia and risk of all-cause dementia, Alzheimer’s disease, and vascular dementia: A systematic review and meta-analysis. PLOS ONE, 20(5), e0318814. https://doi.org/10.1371/journal.pone.0318814
  
  

• Thai references:
  
  

  • ตำราแพทย์ศาสตร์สงเคราะห์
    
    

  • ประมวลหลักการแพทย์แผนโบราณ เภสัชกรรมไทย, กองประกอบโรคศิลปะ กระทรวงสาธารณสุข