- Diseases, Disorders & Conditions
How to Treat Insomnia
Of the many forms of mental suffering, it is doubtful if there is any to be compared with the affliction of persistent sleeplessness. It is most incapacitating to both mind and body. After a succession of wakeful nights there results an extraordinary depreciation in the general health and vitality. Lack of sleep is relatively more dangerous than lack of food. The effects of insomnia are revealed in many ways, irritability of the feelings, blunting of the mental efficiency, lassitude during the day and in failure of physical strength, loss of appetite, poor digestion and a lowered resistance to germ infections.
The key to the successful management of insomnia is an accurate diagnosis of its causes. If these are not tracked down to their source, treatment will only be palliative and the complaint will recur with increasing severity. Generally, the most obvious factors leading to sleeplessness are disorders of the bodily health. Naturally, pain, especially if of inflammatory origin, or due to nerve irritation as in sciatica, neuritis and neuralgia, is a potent disturber of sleep. In heart and chest troubles, the nightly rest is often upset. Feelings of discomfort in the heart region and cough are notable enemies of sleep. Also in cases of high blood pressure, the consciousness of the pulsing of the arteries makes going off to sleep very difficult. A most frequent cause is some form of dyspepsia especially if it is associated with flatulence. In many people excessive bodily fatigue leads to insomnia while in feverish illnesses this symptom is commonly present.
There is an intimate connection between insomnia and certain forms of mental and nervous disease. It is a frequent early symptom of nervous breakdown especially of the anxiety and exhaustion type. In such illnesses, the insomnia, while it is seldom the primary cause, is a very troublesome complication, aggravating the course of the disease and hindering recovery. Mind disorders associated with depression are nearly always accompanied by sleeplessness in the early stages, a symptom which greatly accentuates the sufferings of the patient.
Finally, there is a type of sleeplessness where there is no discoverable factor, either physical or mental. The victims of this insomnia present a difficult problem to the doctor. Their disorder would appear to be due to some definite abnormality of the nervous mechanism governing the sleep rhythm and it is in such cases that the doctor may be reluctantly driven to treat by means of hypnotic drugs.
Treatment of Insomnia
It is well known that sufferers are apt quickly to reach a stage when they despair of ever again enjoying a sound night's sleep. This pessimistic attitude is understandable but it must be resisted strenuously. It is reassuring for these victims to know that most people sleep more than is necessary, just as they eat more than is necessary, and that in all probability their lack of sleep will not permanently damage their health. A correct attitude of mind towards their disability which, in the vast majority of cases, is temporary, is essential as a preliminary to cure. That accomplished, the sufferer should turn the attention to critically examining the mode of life and should endeavor to discover the cause or causes of the insomnia.
To begin with the external physical factors require attention. The bedroom should be well·ventilated, not drafty and not cold. The bed should be comfortable and equipped with a smooth, firm and slightly resilient mattress. The bedclothes should be light though warm.
It is important never to retire to bed feeling cold. In particular cold feet are a hindrance to sleep.
Therefore, when necessary, ensure that the bedclothes are warm (with a hot-water bottle if need be) and old people will find a bedroom fire advantageous to their comfort and their sleep. Experiments should be made with regard to the height of the pillow for this is a determining factor in quite a number of cases. Every effort must be made to safeguard against unnecessary noise especially during the early hours of going to bed. It is to be remembered that the first few hours of sleep are the deepest and most refreshing. A period of mental and physical relaxation should always precede the hour of retirement. With regard to food, this factor varies according to the individual.
It may be emphatically stated that a heavy meal is taboo but some people may find a light meal is helpful to their mental comfort and an aid to sleep. Coffee or tea should, of course, never be taken just prior to bedtime but a glass of warm or hot milk or some egg, malt or chocolate beverage will often be found to be most efficacious in promoting sleep. Baths may be of service in the treatment of insomnia. Here again there is the factor of individual variation to be considered.
With some a hot bath fairly prolonged will be most efficacious; with others a warm or tepid bath will be of greater value.
Massage is another physical method which often gives good service in the treatment of insomnia. A light general massage late in the evening may induce sleep in some or it may be limited to the limbs, a kneading action in the direction of the venous circulation being specially valuable. In other cases gentle stroking movements from the back of the head down to the neck and upper part of the spinal column is best. Gentle stroking of the hair or brushing it for a prolonged period has also been tried with success.
Muscular relaxation is essential for sleep so that when in bed every effort should be made consciously to relax all the muscles. Think of each group of muscles in succession and so ensure their relaxation.
The psychological aspect is naturally of fundamental importance. To anticipate a restless night or to deliberately set out to court sleep is a bad practice. An effort should be made to make the mind a blank and sleep will tend to steal over unawares. It is comparatively easy to stem a flow of thoughts at their commencement but let the mind get active in the quiet of the night and it becomes well nigh impossible to check the race of ideas until the mind is thoroughly exhausted.
Finally, a few words are necessary on the subject of the sleep-producing drugs. There are numerous hypnotic and sedative medicines which when correctly used under the direction of a doctor are of value in the alleviation of insomnia, but they never produce the quality of natural sleep. Their use is only indicated when all natural methods as suggested above have not proved successful, and when the health is being undermined by the insomnia. Given in such cases, their administration should only be temporary, to tide the sufferer over a difficult phase, and the danger of the possible development of a drug habit is ever to be kept in mind.