Insomnia

“ Knowing me to be a neurologist, he asked my advice. I inquired about the patient's former life, but discovered that my traveling companion was little inclined to be communicative in this direction, in fact he was strikingly reticent. To my inquiry about the immediate origin of the insomnia, he told me it was immediately connected with a miserable dream which he had dreamt a month past, and from which he had awakened in terrible anxiety. I asked him to tell me this dream and gave him hope that perhaps the analysis of this might succeed in laying bare the cause of the insomnia. ”

“ SLEEP, REST AND RELAXATION. The late Sir Andrew Clark once said that he never knew anyone die from insomnia, though he knew of many who had died from trying to cure it. To a man who really suffers from insomnia, perhaps, this is but doubtful consolation, but in any case the latter half of this great doctor’s remark is valuable. For probably more poison is taken to remedy insomnia, and on the whole with worse results, than in the alleviation of any other disease which flesh is heir to. ”

“ Probably the most important immediate assurance that can be given to those who come complaining of insomnia is that practically no one has ever {654} been seriously hurt by the wakefulness called insomnia. Patients suffering from brain tumors, from serious disturbance's of cerebral circulation that give objective signs, from various organic diseases, as of the heart or liver, or certain constitutional diseases, have been made worse by the wakefulness induced by their affections. ”

“ While the causes of insomnia may sometimes be exceedingly complex, ordinarily they are evident both to us and those we love the best. Anything, as we all learn by experience, which accelerates the activity of the mind and increases the congestion of the brain is likely to induce insomnia. ”

“ Analysis shows that motives like this are not so uncommon as might be supposed. In other cases insomnia is chosen for the chance it gives for phantasy-building. A person denied the right kind of outlet for his instincts may so enjoy the day-dreaming habit that he prolongs it into the night, really preferring it to sleep. Such a state of affairs is not at all incompatible with an intense conscious desire to sleep and a real fear of insomnia. So strange may be the motives hidden away within the depths of the most prosaic individual! ”

“ In a short time you will find the nerves becoming quiet and you will be able to go to sleep. Sometimes it is good to picture yourself becoming drowsy to induce sleep, and, again, the most persistent insomnia has been overcome by one thinking of himself as some inanimate object—for instance, a hollow log in the depths of the cool, quiet forest. ”

“ The Evening Hours.—The use of the hours after the evening meal is an extremely important factor with regard to insomnia. If the patient tries to read the paper or some conventionally interesting magazine or book, thoughts of the possibility of his not sleeping will surely obtrude themselves and he will fail to get to sleep when he lies down. As a matter of fact, he will have so disturbed himself as to predispose to insomnia. ”

“ This exaggerated dread that slight losses of sleep, for which there are often excellent reasons, will develop into an incurable condition of persistent wakefulness has more to do than any other single factor with the production of the state called insomnia which is, however, never half as bad as it is pictured. ”

“ All fear of insomnia is based on ignorance of the difference between enforced wakefulness and deliberate wakefulness, or insomnia. The man who has acquired the habit may stay awake almost indefinitely without appreciable harm, but the one who is kept awake for a week by a pain, by a chemical poison from infection, or by the necessity for staying up on his job, may easily be in a state of exhaustion. Even in cases of prolonged pain or over-exertion, the body tends to maintain its equilibrium by hastening its rate of repair and by falling asleep before the danger point is reached. ”

“ Worry, fear, grief,16 prolonged mental effort, any sort of emotional excitement, social dissipation, the intemperate use of coffee, tea, or alcohol are among the most familiar causes of insomnia. Disturbances of digestion, neuralgic pains, arterial disease, eye-strain, and dental lesions are the hidden causes, oftener than we imagine, of protracted wakefulness. ”

“ When we are in danger the sleep is light and in snatches, and we thus once more revert to an ancient form of rest and sleep.
The insomnia found in cases of neurosis is a reversion [266] to primitive rest-states, found in the lower animals. The insomnia is due to the fear instinct which keeps dominating the conscious and subconscious mental activities, a state which has prevailed in the early stages of animal life. That is why the sleep of neurotics is unrefreshing and full of dreams of dangers and accidents, and peopled with visions of a terrorizing nature. ”

“ A year ago, as you are aware, I was stricken suddenly with that damnable thing called neurasthenia. For two months I had insomnia in the worst form that a man can have it and live. Sleepy from noon to noon, I only secured thirty minutes of unconsciousness in each twenty-four hours. Figure the situation to yourself. At nine o'clock every night I fell asleep; at half past nine I awoke, and there was not a wink again until nine the next night. I gave up all expectation of recovery, and the most disheartening things I heard were the predictions of Dr. Chambers, that I would ultimately get well. ”

“ For this purpose there are many chapters of this book which point out how various symptoms and syndromes that are often amongst the factors in the production of suicide may be managed. Perhaps one of the most frequent of these is so-called insomnia. Most people are insomniac, mainly because they are overanxious about their sleep. A few of them are wakeful because of bad habits in the matter of work and the taking of air and exercise. Essential insomnia is extremely rare and symptomatic ”

“ How often do we hear people complain that they suffer from insomnia, when in fact they get a reasonable amount of sleep, and indeed often keep others awake by their snoring.
When you wake, get up, for a second sleep does no good. ”

“ I have suffered from insomnia, and in recent months it has been nothing unusual for me to remain awake the entire night. Frequently I stay up all night, realizing the futility of trying to induce sleep. ”

“ It is a curious fact that compulsory wakefulness combined with mental activity often induces a state of morbid insomnia, an absolute inability to obtain the sleep which it was at first so difficult to resist. ”

“ In older children insomnia is common enough. Even when sleep comes it may be light and broken, as though the child slept just below the surface of consciousness and did not descend into the depths of sound and tranquil slumber. We have often noticed how different is the estimate of the patient from that of the nurse as to the number of hours of sleep during the night. The sick man maintains that he has hardly slept at all, whilst the nurse, drawing us aside, whispers in our ear that he has slept most of the night. ”

“ Treatment of Insomnia.—The mechanical measures for the relief of insomnia have for their purpose the withdrawing of the blood from the brain to the surface of the skin. Hot foot-baths; general warm baths; cold douches to the spine, brisk exercise; light massage, and cold rooms. Mental work should be laid aside several hours before retiring; late suppers avoided; coffee, if taken at all, should only be taken for breakfast, and then only one cup. Reading or amusement should be selected that does not excite the nerves. ”

“ Learned, who more than a quarter of a century ago cured himself of habitual insomnia by getting control of the respiratory and circulatory functions in the sleeping posture, has made clear, the problem is simply to shift the belt of attention from the wildly whirling wheel of introspection to the steadier wheel the will revolves. ”

“ Some neurasthenics are afraid to cross an open square or a wide street, others dread any closed apartment. Vertigo is common; so is insomnia. Insomnia is almost a constant symptom. The patient may have naps or he may have uninterrupted vigils. Sometimes there is a heavy but unrefreshing sleep. Sleepless patients are thrown into distracting rage by the barking of a neighbour's dog, the howling of cats, or the cackling of a successful hen, and they haunt the magistrates' courts in efforts to suppress such noises. ”

“ Two Kinds of Wakefulness. As a matter of fact, insomnia is a phantom peril. There is not the slightest danger from lying awake nights, provided one is not kept awake by some irritating physical stimulus. ”

“ For the immediate relief of the insomnia by which the patient is exhausted, a rather complex method is needful. Such subjects often pass the day in tolerable comfort, but, as evening advances, the wearied brain becomes irritable, and bedtime finds the patient in an excited state which cannot be easily overcome by large and repeated doses of chloral. ”

“ The more clearly the patient's sleep is pictured the stronger becomes the subjective feeling of drowsiness. After about ten minutes the ability to give strong concentration seems to disintegrate, attention is renewed only by fits and starts and in the presence of great, mental inertia, and the oncoming of sleep is almost overpowering. An unfailing cure for insomnia, speaking for myself, is the persistent effort to put some one else asleep by hard thinking of the end in view, with a continued gentle movement, such as stroking the other with the hand. ”

“ I. Insomnia caused by irritation of the peripheral portions of the sensory apparatus.
Irritation of the sensory apparatus may be ranked in three classes:
1. Affections of the organs of special sense.
2. Affections of the nerves of common sensation.
3. Affections of the sympathetic nerves.
1. Affections of the organs of special sense.—Prominent among these is the effect of light upon the eye. The darkness of night favors sleep; the presence of light hinders its incidence and renders it less profound. During the gloom of a total eclipse animals seek their shelter ”

“ There is only one answer to this dread, which has no foundation in what we know of actualities, and that is, to tell them the experience of certain persons which absolutely contradicts such a notion. One distinguished physician who, at the age of seventy-five, is writing books that are attracting widespread attention and is doing an amount of work that many a younger man might envy, has told me of all that he suffered from insomnia between the ages of thirty and fifty-five. His mental productivity was much hampered at that time by his wakefulness and anxiety with regard to it. ”

“ External Conditions to be Inhibited.—In the treatment of insomnia two sets of inhibitory conditions are particularly to be looked to, those external to the patient, and those internal. Unless every possible obstacle is removed there can be no assurance of the relief of sleeplessness, while very often the careful regulation of a few conditions that are disturbing the patient will bring sleep fully and promptly. It is curious what small annoyances will sometimes prove disturbing. ”

“ The relief of insomnia in dyspeptic derangement, however, must not be sought through the administration of anodynes and hypnotics alone. Only when the entire life of the patient has been regulated upon a physiological basis can refreshing sleep be obtained. Change of habits, change of occupation, change of locality—these are the only curative measures in a vast number of the cases of wakefulness that occur in modern life. ”

“ This function should therefore be promoted by all means, and we shall devote a special chapter to sleep, its causation, and the treatment of insomnia. Let us, however, at once mention that sleep can best be encouraged by the use of a large, airy room, and going to bed early, say, at ten to half-past, and rising at five or half-past, when sleep has been undisturbed during the night. Seven hours’ sleep is the best; longer sleep, if over seven and one-half or eight hours, injurious, except for anæmic girls and women. ”

“ To the minds of many people insomnia is one of the most serious ills to which human nature is heir. Most of this quite false impression is due to the sensational cultivation of dreads with regard to insomnia by newspapers and in general conversation. ”

“ At present we shall simply point out that each person builds up a set of habits regarding sleep,—as to hour, kind of place, warmth, companionship, ventilation and even the side of the body he shall lie on, and that a change in these preliminary matters is often attended by insomnia. ”

“ Dread of Consequences.—Many people who suffer from insomnia fear that their loss of sleep will injure their intellectual capacity or make them prematurely aged, or drain their vitality so that they will not have health and strength of mind and body when they grow old. This adds to their solicitude about themselves and inveterates their condition. ”

“ In like manner, various poisons, like lead, arsenic, etc., different miasms of telluric origin, the products of putrefaction, and the various animal contagia, may produce insomnia by their prejudicial effect upon the nutrition of the nervous structures throughout the body.
[Pg 56]
CHAPTER III. REMEDIES FOR INSOMNIA.
An occasional attack of wakefulness may fall to the lot of any one as a consequence of the various disturbances of health or equanimity of mind to which all are liable. ”

“ Insomnia.—The proximate cause of sleeplessness is plethora of the cerebral blood-vessels, and a palliative cure can be effected by anything that lessens the tendency of the circulation toward the head. ”