Insomnia

Insomnia, or deprivation of sleep (Lat. somnus), a common and troublesome feature of most illnesses, both acute and chronic. It may be due to pain, fever or cerebral excitement, as in delirium tremens, or to organic changes in the brain. The treatment, when failure to sleep occurs in connexion with a definite illness, is part of the treatment of that illness. But there is a form of sleeplessness not occurring during illness to which the term “insomnia” is commonly and conveniently applied. It must not be confounded with occasional wakefulness caused by some minor discomfort, such as indigestion, nor with the “bad nights” of the valetudinarian. Real insomnia consists in the prolonged inability to obtain sleep sufficient in quantity and quality for the maintenance of health. It is a condition of modern urban life, and may be regarded as a malady in itself. It is a potent factor in causing those nervous breakdowns ascribed to “overwork.” It may occur as a sequel to some exhausting illness, notably influenza, which affects the nervous system long after convalescence. But it very often occurs without any such cause. Professional and business men are the most frequent sufferers. Insomnia is comparatively rare among the poor, who do little or no brain work. It may be brought on by some exceptional strain, by long-continued worry, or by sheer overwork. The broad pathology is simple enough. It has been demonstrated by exact observations that in sleep the blood leaves the brain automatically. The function is rhythmical, like all the vital functions, and the mechanism by which it is carried out is no doubt the vaso-motor system, which controls the contraction and dilation of the blood-vessels. In sleep the vessels in the brain automatically contract, but when the brain is working actively a plentiful supply of blood is required, and the vessels are dilated. If the activity is carried to great excess the vessels become engorged, the mechanism does not act and sleep is banished. In insomnia this condition has become fixed.

When a breakdown has happened or is pending the only treatment is complete rest, combined, if possible, with change of air and scene; but if the mischief has gone far it will take very long to repair, and may never be repaired at all. In no matter of health is the importance of “taking it early” more pronounced. Delay is the worst economy. A few days’ holiday at the commencement of trouble may save months or years of enforced idleness. Sea-air sometimes acts like a charm. But if it is impossible to give up work and leave worry behind, even for a short time, sleep should be carefully wooed by every possible means. In the first place, plenty of time should be devoted to it, and no chance should be missed. That is to say, the night should not be curtailed at either end, and if sleepiness approaches in the daytime, as it often does, it should be encouraged. It is better to lie still at night and try to sleep than to give way to restlessness, and a few minutes snatched in the daytime, when somnolence offers the opportunity, has a restorative effect out of all proportion to the time occupied. Then all accidental causes of disturbance should be avoided. Lights and sounds should be excluded, comfort studied and digestion attended to. Fresh air is a great help. As much time should be spent out of doors as possible, and exercise, even to the point of fatigue, may be found helpful. But this requires watching: in some cases bodily exhaustion aggravates the malady. A little food (e.g. a glass of hot milk) immediately before going to bed is useful in inducing sleep, and persons who are apt to wake in the night and lie awake for hours may obtain relief by the same means. Hypnotic drugs, which have greatly multiplied of late years, should only be taken under medical advice. The real end to aim at is the restoration of the natural function, and the substitution of artificial sleep, which differs in character and effect; tends rather to prevent than to promote that end. It is often possible to induce sleep by rhythmic breathing.