Insomnia; and Other Disorders of Sleep

by Henry M. Lyman

It may at first sight seem to be a contradiction in terms when it is asserted that sleep may result from the administration of a nervous stimulant. This does occur, but only indirectly, and as a consequence of a restoration of energy to those portions of the nervous system which serve to moderate the activity of the organ of the mind—the cortex of the cerebrum.

Heat, for example, is an undoubted stimulant. When added to the body in quantity sufficient to overcome chilliness, it tends to equalize the circulation of the blood, and produces throughout the body a nervous equilibrium that prevents any particular organ or member from arousing the others to wakefulness.

Baths.—The application of heat in the form of a warm bath constitutes one of the most admirable means of tranquilizing the brain. Children who are restless at night are delightfully soothed by a warm bath every night and morning. The water should be of an agreeable temperature—this is better than any exact figure upon the scale of a thermometer—and the bath should not last lounger than ten minutes. Similar baths exercise a happy effect upon adult patients who are moderately feverish, nervous, and wakeful. If strong enough, they may take a full bath at bedtime; but if too feeble to leave the bed, gentle sponging with warm water will prove most refreshing, and will usually be followed by restful sleep. The well-known derivative effects of hot foot baths scarcely need to be more than mentioned in this connection.

Turkish baths form an invaluable adjuvant in the treatment of chronic cases of insomnia arising from rheumatic, gouty, and dyspeptic disorders of the health. The copious perspiration induced by the heated air of the hot chamber is depurative, while the cold douche and the massage with which the bath is concluded have a powerful effect to stimulate all the functions of the body. By this means the brain is enabled to resume a healthier mode of action, and sleep follows as a matter of course.

Massage.—This constitutes a process of rubbing and kneading the body. It has been practiced from time immemorial among the oriental races and the Pacific Islanders as a means of relief from fatigue of every kind. Among the Japanese the practice of massage is a monopoly in the hands of the blind, who are thus enabled to support themselves. Various modifications of the oriental method have been introduced under the names of percussion, shampooing, and the Swedish movement cure. They all possess the common features of friction applied with the hand to the skin, compression of the muscles with the hands, and passive movements of the different articulations of the limbs and body. For effecting all these processes nothing has yet surpassed the Sandwich Island lomi-lomi as practised by the court-retainers of the ancient chiefs. As a means of relieving fatigue, and of removing muscular soreness, after violent exertions of every kind, it is far superior to the imitations performed by European and American professional masseurs and masseuses. Nervous headaches, the pains that accompany spinal irritation, and all conditions of restlessness and wakefulness which depend upon exhaustion are relieved by this method. The well-known soothing influence of a mother’s hand stroking the face and forehead of her sleepless child, is an example of only one of the effects thus produced by the skillful masseur. These salutary results must be assigned to the uniform friction of the skin, causing the liberation of heat, and modifying the electrical conditions of the body. By this, the impressions derived from the peripheral nerves are reduced to a more harmonious series. The circulation of blood and lymph is rendered more active in the substance of the muscles, and all the processes of nutrition are thus stimulated to a degree that restores the equilibrium of function throughout the nervous system. Being no longer irritated by suffering portions of the body with which it is connected, the brain then yields to the effects of its own fatigue, and sleep supervenes.

Electricity is chiefly useful in those cases where it is impossible to discover anything but cerebrasthenia as the cause of wakefulness. According to Beard and Rockwell,[39] sleep may result from the use of any one of the different methods of electrization. The passage of a moderate current, either galvanic or faradaic, through any portion of the body often produces a temporary feeling of sleepiness; but the long continued employment of electricity is needful to effect those changes in cerebral nutrition which are necessary for a permanent cure of insomnia. In cases of sleeplessness caused by worry and overwork, great benefit is often experienced from the daily passage of the faradaic current from the back of the neck, or from the pit of the stomach, to the feet. Static electricity, and the electric bath, are also very effective in many cases of so-called spinal irritation and insomnia.

Counter-irritants are substances which are applied to the surface of the body for the purpose of communicating to the superficial sensory nerves impulses (irritation) which may serve to inhibit the morbid functions of distant or central nervous structures. Various explanations of this process have been presented; notably a most ingenious argument by Dr. T. Lauder Brunton[40] in favor of the theory of inhibition by interference of vibrations—impulses from the periphery interfering with vibrations originating in morbid conditions of the central nervous organs—very much as darkness is produced by the interference of luminous undulations, and silence is effected by interference of sonorous waves in the atmosphere. This hypothesis is the one that is most conformable to the present requirements of science, and is hereby accepted as the most satisfactory explanation of the action of counter-irritants.

The drugs in general use for the purpose of counter-irritation are cantharides, capsicum, mustard, thapsia, turpentine, aconite, and croton oil. Cups, leeches, and certain special applications of electricity, also owe much of their virtue to the same power of modifying functions at a distance. Under the influence of all these agents the molecular vibrations of the brain may be profoundly influenced; pain may be annulled, and sleep be procured. The circulation of the blood is so powerfully affected by these measures that their good effects are usually attributed to the circulatory changes thus produced. But, as in all other modifications of the circulation, the nervous tissues and the vascular channels must first be reached by influences unconnected with the blood itself before its current can be diverted from one region to another. The inhibitory action upon the nervous organs is the primary effect. The diversion of the circulation is a secondary consequence, by which, undoubtedly, the degree of nervous change can be estimated, and by which the inhibitory effects in the brain are intensified and sustained.

Food.—In a considerable number of cases of insomnia, its cause lies in an irritable weakness of the nervous tissues. Exhausted by overwork, or debilitated by the loss of blood, or half-starved during the course of a long illness like typhoid fever, a condition of wakefulness may be established which will add to the dangers experienced by the patient. In this state there is great restlessness—the sufferer experiences no severe pain, but he cannot lie still. This form of sleepless agitation is often encountered during the later stages of exhausting diseases; and, if not properly treated, it soon leads to a fatal termination. The most important remedy for such distress is found in food. This must be soluble, diffusible, stimulant, and nutritive. Milk, alcohol, eggs, and meat-juice, are the typical representatives of such food. Milk should be as fresh as possible, and should be slightly salted, in order to hinder the formation of hard curds in the stomach. For young children it may be peptonized with advantage by gently heating one pint of milk with five grains of sodium carbonate and five grains of pancreatic extract dissolved in half a pint of water. The mixture may be sufficiently warmed by placing it in a bottle immersed for half an hour in a jug of hot water (Fairchild). By this process the milk is partly digested before it is drank, thus relieving the alimentary canal of a corresponding amount of work.

Furnished in the form of koumiss, milk is not only presented in a digestible form, but the alcohol and the acids yielded by its fermentation are powerful aids to the process of digestion. Fermented milk forms a considerable portion of the daily food of the nomad tribes of Central Asia, and it is highly esteemed among the Russians in the treatment of pulmonary consumption. It is useful in all diseases affecting the digestive organs, and can often be tolerated, even by very young children, when nothing else will remain in the stomach. Considerable mystery is made of its preparation by those who sell it for an enormous price; but its composition is really very simple, and its actual cost is within the reach of every one. The following formula for its preparation has given great satisfaction to many of my patients: