Treatment Of Sleeplessness
( Originally Published 1914 )
Training the Mind. Since the chief source from which insomnia flows has to do with a troubled mind, it follows that the most effective remedy is the restoration of tranquillity and the bringing of the mind under control. Where there is fear of sleeplessness this fear must be banished. If the insomniac is in a state of mental irritability and exaltation he must force from his mind. the thoughts that occasion such irritability and exaltation, just as he would force from his hearing the conversation of those all about him while he is being spoken to over the telephone. The training of the mind in this sort of concentration will help wonderfully in his battle against insomnia. To be able to read while the piano is being played in the next room requires the same mental effort necessary in forcing sleep-dispelling thoughts from the mind. If the noise of the piano may be shut out, the will to be awake may be overcome. The hand may guide the pencil over the paper in markings of innumerable down strokes without the brain associating itself with the act, or else each figure "1" traced by the pencil may be followed intently in the mind.
If instead of allowing fear of approaching business disaster to fill his thoughts the insomniac will busy his brain observing and noting his breathing and bring all his mental attention to the task of aspiration and exhalation in slow measured tempo, he will soon find himself sleeping peacefully. Just as sleep may not be had while the teeth are clenched, the fists doubled up and the muscles and nerves strained and contracted, it may not be obtained while the thoughts are jumping from one subject to another as birds jump from branch to branch of a tree, chirping and twittering, but apparently accomplishing nothing. The mind may be as intently occupied in regulating the breathing, in relaxing the muscles of the body and untightening the nervous system as in speculating over the probable fluctuations of the stock market on the morrow or the likelihood of one's position being suddenly lost.
Physical Aids.—Many "systems" of breathing have been urged by physicians of this and other generations as methods of facilitating sleep. In the early part of the nineteenth century one Gardner, who styled himself an "hypnologist," urged sufferers from insomnia, after taking a comfortable position with the pillow occupying exactly a right angle line drawn from the head to the shoulders, to take a full inspiration through the nostrils with lips closed. Having taken this full inspiration, the lungs are then left to their own action—that is, the respiration is neither to be accelerated nor retarded. During this operation, the patient must fix his attention wholly and completely upon his breathing. He must fancy to himself that he sees the breath passing from his nostrils in a continuous thread. The instant he brings his mind to conceive this to the exclusion of all other ideas, consciousness and memory depart, imagination slumbers, thought ceases, the sentient faculties lose their susceptibility, the vital or ganglionic system assumes sovereignty and the individual sleeps.
A somewhat similar method was recently published by Dr. J. B. Learned. The principle is to induce muscular fatigue by exercises carried on in bed. He describes the method as follows: Lying on his back, the patient first reaches for the foot and head board at the same time, he then raises his head half an inch; at the same time he breathes slowly and deeply about eight inspirations to the minute, which are counted. After about twenty inspirations, the head which begins to feel heavy, is dropped. The right foot is then raised, the reaching for the boards and counting being continued, and similarly dropped when fatigued. The left foot goes through the same process. The muscles which are used in reaching for the head and foot boards are then relieved, and the body is elevated so that it rests on the head and the heels. He then turns on the right side and reaches for the head and foot as before. The same process is gone through on the other side. Thus eight positions have been assumed and a large number of muscles used. If sleep has not been induced the same cycle is gone over again.
The method is a strenuous one but I have seen it act in able-bodied hypochondriacs in the most gratifying way.
A well-known educator and moralist, the president of a New England college, advocates the following :
"Assume an easy position, with the hands resting over the abdomen. Take a long, slow, but easy natural breath in such a way as gradually and gently to lift the hands outward by the action of the abdomen. At the same time gradually and slowly open the eyes, so that at the end of the inspiration they are wide open and directed upward. Let the breath out easily and naturally, letting the hands fall in-ward as the outward pressure of the abdomen is withdrawn. At the same time let the eyes drop and the eyelids naturally fall by their own weight, so that they are closed at the end of the expiration. Do all this quietly and naturally. Do not make hard work of it.
"Repeat the inspiration and expiration with opening and lifting, dropping and closing of the eyes ten times. Then take ten breaths in the same way, allowing the eyes to remain closed. Alternate ten breaths with closed eyes.
"When the eyelids begin to feel heavy, and you feel tired and sleepy, as you will very soon, go through the motions more and more easily and lazily, until you merely will the motions without making any effort, or hardly any effort, to execute them. At this stage, or, more likely, in one of the intervals of breathing without any motion of the eyes, you will fall asleep.
"This rule gives the mind two gangs of workmen, two sets of muscles to watch and keep working in harmony. It cannot do this and take account of the work done and at the same time keep up much of a thinking about anything else.
"It induces the respiration that is characteristic of normal sleep. It tires the set of muscles the tiring of which is one of the favourite devices for producing hypnosis. It produces and calls attention to certain sensations in the eyelids which are the normal precursors of sleep. It alternates work in such a way as to make resumption of work more and more unwelcome and rest more and more grateful."
Exercise. This leads to the consideration of exercise as an adjunct in the treatment of insomnia. Probably nothing that the insomniac can do will bring such gratifying returns as appropriate exercise. The best sort of exercise will be the kind that he likes to take and that will fatigue. For the hunter, it is tramping with a gun on his shoulder and a dog at his heels; for the golfer it is going about the links with a good-natured, honest opponent whom he can beat on the seventeenth green; for the sportsman it is following the hounds on a mount which is the envy of every man in the county who knows anything about horse flesh; and so on throughout the list. Most insomniacs, however, must content themselves with walking and bicycling, and such simple gymnastics as medicine ball and tennis, while for others boxing, fencing, swimming, rowing, tennis, squash, and riding may be possible. When the insomniac has no disorder that precludes walking, this is the exercise that may be recommended to him with assurance that if he will devote enough time to it, sleep will be sure to come to him.
Food and Drink Before Retiring.-Benjamin Franklin, writing on the Art of Procuring Pleasant Dreams, has this to say:
"Exercise should precede meals, not immediately follow them; the first promotes, the latter, unless moderate, obstructs digestion. If, after exercise, we feed sparingly, the digestion will be easy and good, the body lightsome, the temper cheerful, and all the animal functions performed agreeably. Sleep, when it follows, will be natural and undisturbed. While indolence, with full feeding, occasion nightmares, and horrors inexpressible; we fall from precipices, are assaulted by wild beasts, murderers and demons; and we experience every variety of distress. Observe, however, that the quantities of food and exercise are relative things those who move much, may and indeed ought to, eat more, those who use little exercise, should eat little. In general, mankind, since the improvement of cookery, eats about twice as much as nature requires. Suppers are not bad, if we have not dined; but restless nights naturally follow hearty suppers, after full dinners. Indeed, as there is a difference in constitutions, some rest well after these meals; it costs them only a frightful dream, and an apoplexy, after which they sleep until Doomsday. Nothing is more common in the newspapers than instances of people, who, after eating a hearty supper, are found dead abed in. the morning.
"Not a few find it advantageous to expose the unclad body to the cool air, to make cold ablutions, to take warm foot baths or to hold the feet for a few seconds under running cold water. All of these. may at times be indulged in advantageously, especially if the insomnia is due to mental causes or upon habit."
Other Devices. Another recommendation of Benjamin Franklin that has fallen into disrepute which it does not deserve, I quote here :
"A shock of cold water has always appeared to me, generally speaking, as too violent, and I have found it much more agreeable to my constitution to bathe in another element. I mean cold air. With this view, I rise almost every morning and sit in my chamber without any clothes whatever, half an hour or an hour, according to the season, either reading or writing. The practice is not in the least painful, but on the contrary agreeable; and if I return to bed afterwards, before I dress myself, as sometimes happens, I make a supplement of my night's rest of one or two hours of the most pleasing sleep that can be imagined. I find no ill consequences whatever resulting from it, and that at least it does not injure my health, if it does not in fact contribute much to its preservation. I shall therefore call it for the future a brainy or tonic bath."
And in another connection he writes:
"When you are waked by any uneasiness, and find you cannot easily sleep ,again, get out of bed, beat up and turn your pillow, shake the bedclothes well, with at least twenty shakes, then throw the bed open, and leave it to cool; in the meanwhile, continuing undrest, walk about your chamber, till your skin has had time to discharge its load, which it will do sooner, as the air may be drier and colder. When you begin to feel the cold air unpleasant, then return to your bed; you will soon fall asleep, and your sleep will be sweet and pleasant. All the scenes presented to your fancy, will be of the pleasing kind—I am often as agreeably entertained by them as by the scenery of an opera. If you happen to be too indolent to get out of bed, you may, instead of it, lift up the bedclothes with one arm and leg, so as to draw in a good deal of fresh air, and, by letting them fall, force it out again. This repeated twenty times, will so well clear them of the perspirable matter they have imbibed, as to permit your sleeping well for sometime afterwards. But this latter method is not equal to the former.
"Those who do not love trouble and can afford to have two beds, will find great luxury, in rising when they wake in a hot bed, and going into the cool one. Such shifting of beds would also be of great service to persons ill of a fever, as it refreshes, and frequently procures sleep. A very large bed, that will admit a removal, so distant from the first situation as to be cool and sweet, may, in a degree, answer the same end."