Insomnia; and Other Disorders of Sleep

by Henry M. Lyman

Dilute five quarts of milk with three quarts of hot water. When lukewarm, add half a cupfull of sugar of milk (which can be obtained from any wholesale druggist), and one bottle of well fermented koumiss (or a little yeast). Stir the mixture thoroughly, and let it stand in an open jar, at a temperature of about 72° F., till it begins to curdle. Then stir in half a cupfull of pulverized coffee sugar, and cork tightly in champagne bottles with the best velvet corks. The bottles should be kept quite cool, as fermentation proceeds very briskly, and will break the containers if left in a warm room. A large ice-box is the best receiver during hot weather. The koumiss thus prepared is ready for use at the end of a week. It may be most conveniently drawn from the bottle with a champagne tap. The entire cost of the article need not exceed seven cents a bottle.

Sleeplessness caused by chronic dyspepsia will often yield to a diet of koumiss, when every other remedy has failed. When the stomach is very intolerant, it should at first be taken in very small doses, repeated as often as every hour. It will soon become possible for the same patient to drink two or three quarts each day.

Eggs form one of the most nutritious and easily digested articles of diet. They should be taken uncooked, beaten up with milk to which a small quantity of wine or spirits and sugar have been added. A glass of eggnogg, thus prepared, is invaluable in the insomnia of fevers and other conditions of exhaustion.

Meat-juice can be procured in numerous forms. The various soluble extracts of meat, Valentine’s liquid extract of beef, Murdoch’s liquid food, all represent the juice that oozes from rare beef. Its nutritive value is not very great, but it possesses considerable energy as a stimulant. Meat juice, therefore, occupies an important place as an excitant of those functions which must be aroused in order to secure the proper digestion of other articles of food. It should, therefore, be administered in connection with them. As the ordinary meat extracts are frequently very unpalatable, they may be administered in fresh broth or soup, to which they give body and energy without unpleasantly affecting their savory taste.

Neurasthenic patients, whose insomnia results from physical exhaustion, should never retire at night without taking some form of light and easily digested food. A simple slice of bread, or a piece of plain sponge-cake, with a glass of koumiss, forms an excellent model for such a meal.

Digitalis is only indirectly useful as an hypnotic. In cases of cardiac disease, with enfeeblement of the heart, dyspnoea, dropsy, and sleeplessness, digitalis is often of the greatest service. It has also been highly recommended in delirium tremens. Administered in the form of an infusion, it has been given in doses of a tablespoonful, every four hours, with apparently good effect. Its use is indicated in cases characterized by weakness of the heart, with a rapid and feeble pulse. Under its influence the state of the circulation improves, delirium ceases, and sleep occurs.

Camphor.—This substance is not an hypnotic, but it forms a valuable addition to various hypnotic compounds. It is a cerebral stimulant, and aids in the establishment of that nervous tranquility which favors the incidence of sleep. It may, therefore, be advantageously associated with opiates in the restlessness and insomnia of exhaustion. Tully’s Powder, a valuable substitute for Dover’s Powder, contains camphor. This renders it preferable to the ordinary opiates in typhoid fever, and in other exhausting diseases.

Musk, the dried secretion of the preputial follicles of the musk-deer, is a substance which, on account of its high price, is rarely used as an hypnotic. Given in doses of ten grains, every two or three hours, it is exceedingly valuable (Stillé and Maisch) for the relief of “all those nervous phenomena which are represented by the term ataxia, and among them subsultus tendinum, mild muttering delirium, floccitation, muscæ volitantes, and hiccough, with a small, frequent, tremulous or irregular pulse, without coma and without collapse. Under these circumstances musk tends to produce refreshing sleep, while it calms muscular spasm and favors perspiration, while the pulse grows fuller, more regular, and less frequent.... In proportion as ataxic prevail over adynamic phenomena is musk advantageous.” Such conditions are chiefly encountered in typhus, typhoid fever, the eruptive fevers, and pneumonia. Musk is very efficacious for the relief of “wakefulness resulting from combined mental and bodily fatigue—such cases, in fact, as are benefitted by valerian, camphor, asafetida, and ammonia.”

Valerian and its different preparations form a typical class of agents which indirectly favor sleep by their gently stimulant effect upon the brain. They are all useful in quieting that form of hysterical excitement to which women are liable during the “change of life.” That form of restlessness, usually resulting from fatigue, in which the patient feels as if she cannot sit still, is often relieved very promptly by the valerianate of ammonia. Wakefulness caused by neuralgic pains, or by exhaustion, often yields readily to scruple doses of valerianate of zinc or ammonia. The elixir of the valerianate of ammonia is a very elegant preparation of the drug.

Cannabis Indica.—A cerebral stimulant which produces, at first, an agreeable exaltation of the mental faculties. This is followed by a condition of delirium, succeeded in its turn by sleep. It is, therefore, impossible to use the drug for merely hypnotic purposes; but it is a useful adjuvant, in small doses, to other hypnotic remedies. Given in doses of ½-1 grain, it may be advantageously associated with opiates, or with hyoscyamus or belladonna in cases which do not easily tolerate the preparations of opium. The tannate of cannabin, given in doses varying from five to ten grains, has been recommended as an hypnotic; but, like the extract from which it is derived, its effects are rather uncertain. The pure alkaloid, cannabin, has been recently introduced as a soporific, in doses of three-quarters of a grain to a grain and a half. According to Stillé and Maisch, the wakefulness caused by the itching of eczema may be relieved by the use of cannabis indica. The uneasy sleep attendant upon ungratified sexual appetite may also be relieved in the same way, since the drug is decidedly anti-aphrodisiac.