Part 4

Drugs which induce sleep induce it merely for the time. Doctor Caillé in his large experience has found morphia invaluable for the inhibiting of pain or of severe dyspnœa, chloral and the bromides useful in cases of visceral neuralgia, codein and urethan in arteriosclerosis, and in pulmonary tuberculosis, where beer and porter failed to bring the longed-for sleep, dionin, trional, and hyoscin. But in ordinary cases of insomnia, where the cause is evidently more psychical than physical, he is inclined to turn rather to suggestion in one form or another.

Drugs are sure to make a difference in the morning. The dulness and depression which they leave behind, in spite of all the claims of those who put on the market their proprietary hypnotics, offset to some extent the artificial sleep they have the night before produced. Sometimes they fill the mind for days with morbid fancies and with dangerous obsessions. Dr. J. Madison Taylor describes in some detail the case of a lunatic under his care who developed homicidal tendencies as a consequence of the administration of large doses of bromide, and who lost the same the moment the bromide was withdrawn from him. On credible authority I am informed that there is among the alienists a growing disposition, on this account, to give no drugs at all to induce sleep in patients in the higher class of hospitals for the insane.

Morphia is not only no specific; it sometimes causes both a mental and a physical depression worse than the insomnia it would relieve. In my clinic I have one woman from whom morphia, administered to relieve acute pain, took away the power to sleep at all, and for years she stoically bore her pain rather than resort to morphia, until last winter she found in the Emmanuel treatment immediate and unfailing relief from pain, followed by sound sleep, which has only at rare intervals been interrupted in months past.

Powerful as chloral is and useful in the thoughtful doctor’s hands in various emergencies, especially in fevers where there is cerebral excitement, it is a depressant, and he who contracts the chloral habit invariably wishes at the last that he had waited for damnation till after he was dead. Sulphonal, trional, veronal, paraldehyde, and those proprietary hypnotics whose composition is withheld from the public appear to be least harmful of all sleeping drugs. But they all inebriate or stupefy the fragile cells of the brain, none too solid in the best of us; and in the psychically weak or emotionally excitable they may even put the delicately constructed thinking organ altogether out of commission.

FOOTNOTES

Differential Diagnosis and Treatment of Disease, 78, 355, 361, 457, 731.

Popular Science Monthly, September, 1905.

THE REMOVAL OF ALL PHYSICAL CAUSES

Though there may be no specific for insomnia in the drug store, the complaint can often be relieved when the cause is wholly physical by striking at its root. If the general practitioner fails to relieve disturbances of the digestion, the stomach specialist should be consulted. One of my patients, who had for two years suffered both from insomnia and other troubles which had exhausted the ingenuity and the resources of the local doctors he consulted, began to improve as soon as a stomach specialist of national repute to whom I sent him discovered by chemical analysis of the contents of his stomach an incredibly excessive acidity, for which the proper prescription and diet were at once suggested.

In cases where insomnia is evidently due to some physical ailment which cannot be at once located, a visit to the oculist, the dentist, and even the throat and nose specialist should as a matter of course be paid even if the patient has no conscious need of them. In at least two instances which have come under my observation, the insomnia disappeared after proper treatment of the eyes and teeth and throat, though two general practitioners had suspected nothing wrong in one case with the eyes, and in the other a visit to the throat specialist was never once suggested by the doctor who sent the case to me for the Emmanuel treatment.

FOOTNOTES

As the proof comes, the patient in question writes me that his insomnia was of the fitful type. He had so much trouble in going to sleep promptly that he formed the habit of sitting up late and inducing the sleep mood by reading. Since his treatment ended, he writes me (Sept. 12th), “This summer I have retired at nine o’clock with few exceptions, gone to sleep immediately, and risen at half past six in the morning thoroughly refreshed.”

GENERAL DIRECTIONS

In many cases no local ailment would appear to be responsible for the insomnia, and yet in every instance attention must be given to the body’s entire needs. The habit of deep breathing from the diaphragm must be developed and be regularly practised both indoors and out. This alone sufficed in one complicated case to bring sleep every night. The diet must be carefully chosen and followed in the face of every importunity of a silly and capricious appetite. Tea and coffee, save at the morning meal, must be in almost every case eliminated from the menu. Constipation, which is responsible far oftener than we think for sleeplessness, must be, whenever possible, at once corrected without resort to purgatives and enemas. The hot bath sometimes brings sleep by relieving the congestion of the brain, but contraction of the blood-vessels often follows with such promptness that the hot-water bottle applied to the feet or the back of the neck or both is likely to be of more service.

If running up and down stairs or exercise in that wood-pile now imaginary in the average home leaves the sufferer as wide awake as ever, Doctor J. B. Learned’s provision for taking exercise in bed without displacement of the covering will sometimes relieve both the cerebral congestion and the psychical exhilaration and let the wakeful one drop off to sleep at the drowsy moment, which is apt to pass if the exercise is taken out of bed and even scanty preparations have in consequence to be made for retiring.

FOOTNOTES

See Dubois’s Psychical Treatment of Nervous Disorders, ch. xxiii, for the drugless cure of constipation.

SECONDARY AIDS TO SLEEP

When the sleeplessness is due to mental strain alone the cure can be effected through the quiet mind. This is, I know, not always easy to obtain. Conditions do not always favour it. Economic pressure does not disappear at will with prices rising and with factories operating on half-time. When the heart aches for

the touch of a vanish’d hand, And the sound of a voice that is still,

grief is scarcely to be put away without some seeming hurt to the best in us. For many a subject to insomnia the most that can apparently be done is to stand cheerfully and confidently between him and the temptation to grow morbid and melancholy, to keep the house as quiet as circumstances will allow, to provide for the bedtime hour a glass of hot milk with its pinch of salt in it, the hot malted milk unsweetened, the clam bouillon, the beef extract, or a cup of cocoa which every insomniast should take before he goes to bed, and by day and night to soothe, sustain, and cheer the troubled spirit.

DR. LEARNED’S PLAN

The physiological problem is uncomplicated. As Dr. 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.

By deep regular respirations, accompanied by rhythmical movements of the head and hands and feet, Dr. Learned has frequently brought the wandering attention back from some side track it sought in fitfulness to the main line of the controlled consciousness. So surely has he in recent years become convinced that the problem is usually psychical that he no longer emphasises physical exercises in or out of bed. Instead he provides an ingenious little tablet on which the wakeful one with unlifted pencil steadily records in waving lines his inhalations and his exhalations until at last, fatigued by the long exercise, the brain becomes anæmic and sleep overtakes the drowsy mind.

RELAXATION AND RHYTHMIC BREATHING

To Mrs. Annie Payson Call and Dr. Emily Noble we owe of late the stress we lay on muscular relaxation and rhythmic breathing, which practised faithfully will now and then bring sleep where drugs are worse than useless. Muscular relaxation can be learned by any who will take the trouble. The Delsarteans are already adepts at it. The letting of the arms drop limp by the side as one sits in an easy chair, the letting of the trunk sink unsupported against the easy chair as though it were sinking into a yielding bank of snow, the letting of the head fall forward or sideways without resistance will furnish even to the slow of wits a visual image which will serve as a sufficient pattern in the relaxation of the whole body.

Dr. Emily Noble, who has seen Oriental soldiers at the end of a long march throw themselves in complete relaxation on their backs, gives in her Rhythmic Breathing plus Olfactory Nerve Influence on Respiration possibly the most practical of all directions for the mature in the important art of relaxation. She bids him lie upon his back on a hard surface, with head turned to one side in order to relieve the tension on the muscles of the neck, with arms extended at right angles, with the palms turned up, with feet turned out and spread for comfort at least a foot apart.

The lungs are then to be cleared of their static air by a few deep inhalations, made through the left nostril because in the average man it seems to furnish a freer channel for the air than the right nostril. Next the insomniast settles down to lighter rhythmic breathing, which is nothing but the consequence of the conscious effort to make each exhalation equal to each inhalation. He should take the “breath in as gently as the fog creeps in from the sea.” He should let it out “as the air goes out of little children’s balloons when it is allowed to escape.”