Insomnia Due To Physical Causes
( Originally Published 1914 )
BEFORE attempting to instruct the sleepless as to the method and manner of overcoming insomnia the form and character of the evil from which they suffer must be ascertained.
Insomnia not a Disease.—Insomnia is a symptom, not a disease. It is a derivative, a by-product, the effect of definite causes, which must first be removed before any progress can be reasonably expected in the work of regaining sleep. For the purpose of determining the proper treatment to be adopted, it may be well to divide insomnia broadly into two distinct classes. First, insomnia springing from purely physical causes. Second, insomnia derived from mental, moral or emotional causes.
The first has its origin in physical pain or discomfort. It may be a mashed thumb, rheumatism, cold feet, indigestion, influenza or the toothache. Generally the treatment here is simple. Remove the cause and the effect will disappear. Ease the aching tooth and sleep will come.
The other insomnia is born from grief, cares, expectations, anxieties, great business, and all violent perturbations of the mind. It may be due to anything that exalts, excites and makes unaccustomed appeal to the special senses. This is the most persistent variety. Not infrequently it is the initial symptom of many mental diseases.
Insomnia derived from this disordered mental condition is prone to engender in the mind of the sufferer the fear of approaching insanity. "I am sure I shall go mad," is a frequent statement from insomniacs of this character. Fortunately this fear is groundless. Sleeplessness does not cause insanity. The victim may be-come depressed, irritable, excitable, inattentive, but his senses will not forsake him. I have seen so much suffering result from ignorance of this fact that I purposely emphasise it here. Fear of disease is sometimes worse than the disease itself and the suffering incidental to such fear cannot be measured. The unhappy and unfortunate victim of insomnia has enough to contend with. Let him banish forever the fear that the integrity of his mind is threatened.
Before taking up the detailed analysis of mental insomnia, let us consider the less complex form of physical insomnia.
"Physical" Insomnia.—Grouped under this head are many passing discomforts which, from the fact that they occasion only temporary sleeplessness, only enter incidentally into a study of insomnia. A slight irritation of the throat accompanied by an annoying tickling sensation of the larynx is quite sufficient to keep the emotional human being awake. Trivial matters such as chilblains or an itching skin disturb sleep as effectively as rheumatism or indigestion. Where spraying the throat or anointing the inflamed epidermis with some oleaginous salve will readily effect a cure of the minor ailments cited ; however, in the case of indigestion or rheumatism the matter is not so simple.
Indigestion is of many kinds and varieties. We speak of stomachic indigestion and intestinal indigestion, of indigestion due to perversion of the digestive juices, to disturbances of motility of the digestive tract, to the formation of such deleterious processes as fermentation, to a disturbed nerve supply of the digestive organs, etc. It is unnecessary to consider the different forms here in order to discuss the treatment of insomnia which results from indigestion, except to say that success can attend our efforts only when the underlying cause of insomnia, namely, the indigestion, is sought, detected and successfully combated. Of all the varieties of indigestion which cause disturbed sleep those which are attended with fermentation, especially when this provokes flatulency and pain, are the most important. In making this statement it is realised that one of the most obstinate forms of insomnia to overcome is the variety dependent upon disturbance of circulation, such as arteriosclerosis which in. turn is dependent upon chronic indigestion and fermentative processes in the intestines.
The victim of indigestion who does not put himself in the hands of a physician who will determine the underlying cause, is not giving himself a fair chance. Much is heard nowadays of the necessity of popular lectures to familiarise the average intelligent laity with the findings of science. I know of no field that would yield a more favourable or beneficial crop of information than the plain and truthful setting forth of the fact that medicines are practically of little or no use in the treatment of chronic diseases or any other diseases, save temporary functional provisions of the different organs of the body.
Unless one happens to be a member of a drug taking family, or a physician, and especially a hospital physician, it is almost impossible to realise the bondage in which drugs hold many of our fellow beings. The indiscriminate taking of drugs apparently has no relationship to intelligence and common sense. Men and women whose daily life and work testify to their equanimity, their good sense and sound judgment, pour drugs into themselves for the relief of this or that minor ailment, in a way that transcends all understanding. And for no disturbance of functions are drugs taken so indiscriminately as for disorder of the digestion.
The amount of money spent on pepsin, pancreatin, takadiastase, charcoal and so-called intestinal disinfectants in this country could establish a fund, which, if wisely used for popular education, would in one generation do more to overcome indigestion than all the drugs in the world. To many it will come as a decided shock that there is scarcely a particle of evidence to show that any of the substances enumerated above are of any value. The most elaborate investigations made on intestinal fermentation to demonstrate the value of so-called intestinal antiseptics have shown conclusively that the only drugs which have any effect in diminishing fermentative processes in the intestines are those which stimulate the action of the intestines to remove the offending substance from the body..
One of the common manifestations of such indigestion is flatulency. Flatulency, which seems to be the immediate provoker of sleeplessness, often produces its worst effects, when we are not conscious of its existence, by eructation or expulsion of gas. When we suffer from flatulency in the ordinary sense, we are conscious of the desire to get rid of, or disperse, the gas. When it is tolerated by the stomach this gas produces an oppressive pain around the heart.
Of the many expedients that may be utilised for the treatment of sleeplessness due to flatulence, the simplest is a glass of hot water at bedtime and it is usually effectual. Its efficiency may sometimes be enhanced by the addition of a simple aromatic, such as a few drops of spirits of peppermint or aromatic spirits of ammonia. It should be taken a half hour before going to bed, as the movements of undressing facilitate the expulsion of gas from the stomach either by eructation or by sweeping it into small intestines where contact with the bile, which is antiseptic, prevents further fermentation. If this simple remedy is not adequate, the administration of a teaspoonful of compound tincture of cardamom may be added.
Dry heat to the pit of the stomach, such as a hot water bag or a hot plate, or vigorous friction and manipulation of the abdomen, is some-times very serviceable. In cases of flatulency that are rebellious to these simple measures, it is essential that the contents of the stomach be taken and analysed in order that the cause of fermentation be determined. It is in such cases that washing out of the stomach is often-times of signal service.
There are many conditions of circulation that cause insomnia. Among these, cold feet is the most important. It is, I fancy, the commonest immediate cause of insomnia. Itself a symptom of disordered digestion, constipation, anaemia or other disease, it stands Cerberus-like between the disorder and Nature's restorer. The condition of which it is the expression may have to be thwarted before it is overcome.
Much can be done to counteract its effect by a few simple measures, such as holding the feet for a few seconds alternately under a stream of hot and cold water, then frictioning the feet and legs vigorously and enveloping them in warm flannel up to and above the knees. It is incredible how much difficulty has been encountered in getting this simple and frequently efficacious measure carried out. It is too much trouble for the majority of those to whom it is recommended. A hot water bottle is so much easier though it is much less useful. It may be that the languor and weakness which such persons display are but a part of the general sluggishness of circulation indicated by the coldness of the extremities.
Coldness of the feet is apparently the cause of sleeplessness in many brain-workers who are free from anaemia and poor circulation of blood. It is not a negative coldness which can be overcome by external warmth. It has to be righted through the general circulation. It is in such cases that a hot, mildly stimulating drink such as hot milk, cocoa or beef extract, on retiring is most beneficial. Such a procedure is particularly potent in overcoming insomnia if the feet are thrust into cold water and vigorously rubbed for a few minutes.
Sleeplessness due to burning sensation in the feet is a more stubborn cause of dysomnia than cold feet, for when it occurs in its most exaggerated form it is an indication of some graver disorder than cold feet. The treatment of it is the treatment of the underlying cause.
Insomnia associated with, or dependent upon, structural disease of the blood vessels known as arteriosclerosis is often most rebellious to treatment. In every case of such arterial disease it is essential that the blood pressure or arterial tension shall be determined, and this can be done only by the physician. It is a well-established fact that high blood pressure and insomnia often go together. There again it is essential to search for and counteract or remove the cause of the arterial tension. In the majority of instances this is some form of intoxication arising within the system or the expression of such disorder of metabolism as gout or diabetes, any of which calls for the most rigid dietetic treatment. Indigestion in one form or another, but particularly fermentative intestinal indigestion, is the common forerunner of these conditions, and I shall refer to the treatment of it when discussing the relationship of dyspepsia to insomnia.
The insomnia of arteriosclerosis is often successfully combated temporarily by instructing the patient to take a small amount of timulant such as whisky and hot water or milk before retiring and repeat this early in the morning.
While the insomnia that springs from physical pain or discomfort is easier to eradicate than that which originates from mental or emotional causes, it frequently happens that through failure to combat the ailment in its milder manifestation, what was at first but a physical reflex becomes mental also. The principle "Mens sana in corpore sano" applies to nothing so aptly as to insomnia. If the body be healthy the mind will be sound. It is when the body is driven from day to day in a condition half way between sickness and health with perhaps a disabled kidney or liver insidiously sapping away life's elixir, that the foundation is laid for one of the most persistent forms of insomnia.
The patient will not ascribe his inability to sleep to malnutrition or to poor circulation, and since his mind is free from mental anxiety concerning the stock market or his wife's coquettishness, he will be at a loss to explain his sleeplessness to himself. At this point he will be likely to take quick alarm at his condition and to jump at the conclusion that his inability to sleep is a disease in itself and not merely a symptom. He will become panic-stricken at the apparently inexplainable, and instead of harbouring the constructive thought of sleep will fasten and brood upon the destructive thought of insomnia.