Baths.–Of the known physical measures in the treatment of insomnia the external application of water is among the most efficacious. A prolonged warm bath (98 to 102 degrees Fahrenheit, lasting from ten to twenty-five minutes) with the addition of some volatile substance that irritates the skin and causes a gentle, pleasant stimulation of the blood circulation on the surface of the body, such as pine needle extract, is frequently most serviceable in overcoming insomnia due to fatigue, exhaustion, worry and disagreeable sensations, not amounting to real pain, coming from different parts of the body.
Insomnia associated with pain of what is commonly called a rheumatic nature, that is, pain due to inadequate elimination from the system of products of combustion, and insomnia accompanied by motor unrest commonly called “fidgets” is frequently relieved by a bath at the temperature of 102 to 108 degrees F., and of ten minutes duration. Upon emerging from this bath, the individual should wrap himself in a warm flannel blanket until all the moisture is absorbed, when he is ready to don his night clothes and sink peacefully into sleep.
When there is no constitutional weakness and the system is able to withstand the shock of cold water, the treatment known as the dripping sheet has proven of great benefit. The patient stands in a foot tub of hot water with a towel dripping with ice water wrapped about his head. A linen sheet is then taken unwrung from a basin of ordinary cold water (60 degrees) and thrown over the back of the patient while a few rapid movements of the hand bring it in contact with every part of the body. Brief friction is made through the sheet after which it is removed, the body dried quickly and the patient put to bed. Often sleep follows within a few minutes.
Another method tried with success is the abdominal compress. The method here is to apply a compress of four or more layers of flannel, large enough to cover the entire abdomen, taken dripping from cold water of from 50 to 60 degrees. This is covered with enough flannel to keep the clothing from getting wet and is allowed to remain in position an hour or more and even through the entire night should the patient be found to be asleep and the removal of the compress render likely his awakening.
So-called tonic baths have also been found of great remedial value. As given in hydriatic establishments they consist in the vigorous application of water, alternately hot and cold, from the nozzles of water hose under adjustable pressure and through perforated pipes arranged as a circular cage and known as needle and shower baths.
Taken during the day, the tonic bath invigorates the patient, invites him to beneficial effort such as exercise, favours the sensation of relaxation and improves the circulation and nutrition. Taken at the bedtime hour, it has a sedative effect. At first, extremes of temperature should be avoided, as otherwise the end which is desired may be defeated and the patient become more excited than before. A moderately low temperature of from 65 to 70 degrees, reduced two or three degrees at every application, I have found to be more practical than an extremely low temperature from the first. It has been my experience that patients respond better if they become accustomed to the use of cold water than if a cold blanket, so to speak, is thrown over them from the first. Many patients thus treated never recover their confidence sufficiently thereafter to make ready response to the treatment and it is therefore wiser to make haste slowly and not ,try to cure by one application.
Where the patient may not avail himself of the commodities of a hydriatic establishment, the following substitute may be resorted to. The patient sits or reclines for five minutes in a tub half or one-third full of water at a temperature of from 75 to 85 degrees, while the skin is vigorously frictioned by an attendant or nurse.
PacksWarm and Cold.Very good results, particularly in individuals of a high-strung and nervous temperament have been obtained from the use of cold packs and warm packs. The drawback to them is that they may only be applied by trained nurses or individuals having had some experience. A cold pack at bedtime relaxes the nerves and invites repose. The sensation of tension nearly always present is relieved and sleep readily induced, particularly if a gentle massage follows.
The night wet pack is administered as follows : First spread upon the cot or bed three large sized woollen blankets with the top ends placed half way over the pillow in order that they may be drawn smoothly about the neck and shoulders, then spread over the blanket a linen sheet or a large sized table cloth wrung out of water at 75 degrees (reduced two degrees each succeeding application). The sheet must be wrung as dry as possible, as any superfluous moisture retards reaction. After spreading the sheet upon the blankets which have already been prepared the patient is instructed to lie down and one end of the sheet is brought around the body (the arm meanwhile having been raised), then over one leg in order that no part of the body touches another. Then lower the arms and wrap the other edge of the sheet over the arms and between the legs. If the feet are cold it may be wiser not to wrap them in wet sheets. The blankets are then wrapped about the patient as securely as possible in or-der to exclude the air. The patient having been placed in the middle of the blanket, there must be an even margin on either side which must be wrapped alternately beginning at the neck where it must be wrapped closely and firmly though it must not bind across the back of the neck or throat either of which will produce a headache. After the first layer of blanket is put about the patient a hot water bottle can be placed against the feet, care being taken that it is not too hot or too near the wet sheet. The remaining layers of the blanket are then arranged alternately, and lastly a cold compress is placed on the head and changed occasionally.
A glass of water may be given twice during the hour that the patient is in the pack. Before it is time to remove the patient from the pack, the half bath should be prepared. Draw water of the required temperature (90 to 95°F.) about a foot in the bath tub, then have a foot tub or other receptacle filled with water 10 degrees lower with a dipper at hand to use for the effusions.
In removing the patient from the pack he should not be entirely exposed, but leave one blanket to protect from chilliness on the way to the bath. Immediately upon entering the tub the patient should be rubbed vigorously over the entire body and the exposed portion, which will be from the waist up, must not only be rubbed but slapped, not with a heavy blow, but a light, tingling slap, followed by water dashed upon the shoulders and chest. Have at hand a linen sheet and wrap it around the patient when taken from the tub and rub quickly (not with the sheet) until dry, using friction and slapping. This procedure is frequently enhanced by massage after the patient has been put to bed, and by giving some hot drink.
Massage. Insomniacs whose sleep disturbance can be traced to mental causes find great relief in massage. The best results are obtained by subjecting the patient to gentle massage and inducing physical reaction and mental appeasement by light surface contact. Where there are no bodily infirmities and where it is necessary to occasion a certain degree of lassitude, the treatment may be more vigorous and partake of the rough fundamental muscle kneading given to athletes.
Massage for insomnia must vary with the patient. A high-strung, nervous patient should be treated in the morning or early in the day otherwise he or she will get wide-awake and excited. Others will be soothed and fall into a quiet sleep after an evening treatment. The operator is instructed not to talk to the patient, especially after the back has been attacked and to finish the treatment with long, gentle strokes on the head and down the arms. The patient will then be turned on the side and covered properly and the windows opened wide.
In many instances, massage of the feet is of great service. I have also observed that in cases of sleeplessness springing from the continued occurrence of the same train of thought, the insomnia will yield to light massage of the head. Many nervous individuals go to sleep easily while their hair is being smoothed, a survival of a custom long practised in the nursery.
Bedtime Suppers. Whether or not insomniacs should take food upon retiring is a question which physicians are frequently called upon to answer. All that can be said is that it depends upon the individual and upon his habits and customs.
It is a fact that the average human being feels a physical drowsiness after taking food. This phenomenon occurs not only in human beings, but in all animals. It is very manifest in the lower animals, all of whom display the greatest disinclination to be active after feeding. In a general way, it may be said that it is prejudicial to health to consume such a quantity of food as will cause a sensation of leaden drowsiness after it is taken.
The relationship which exists between insomnia and indigestion is only once removed from that which exists between normal digestion and drowsiness.
A bedtime supper is likely to be injurious to a person who has taken a full meal only three hours earlier. On the other hand, those who are accustomed to taking only a light supper and that early in the evening find their sleeping greatly benefited by taking a glass of sour milk and a biscuit, a cup of hot malted milk (providing they have no tendency to sour stomach) or a cup of hot broth on retiring. This comes from the fact that many who suffer from insomnia have disordered nutrition and lowered vitality. To counteract this, it becomes advisable to get easily digested food into them frequently. We therefore have to avail ourselves of the bed hour to administer it and if we find, as is sometimes the case, that such administration facilitates going to sleep, it is gratifying. Particularly is this overfeeding effective where intestinal indigestion and disorder of the blood-vessels exists. In these cases it has been found that the digestion of a large amount of food is conducive to sleep. It is currently stated that such somnolence is due to cerebral starvation of the brain caused by the demands of the stomach upon the available energy, but it is more legitimate to attribute it to a form of self-intoxication.
The maxim that “We all eat too much,” while it contains some truth, is not nearly so all-embracing as the statement that what is too much food for one person is not enough for another. One of the healthiest men I have ever known who died at eighty-three from natural causes ate every day of his life quite enough food to sustain a small family. I never heard him ask, “Is it good for me?” and he ate what he liked and as much of it as he craved. Were his neighbour to do the same, he would soon fall a victim to gout or become subject to depression and inertia. Overeating has relation to insomnia only in that it causes indigestion and disease of the arteries.
Electric Treatment. Electricity which at one time or another has been hailed as curative of practically every disease has been tried with varying success for the treatment of insomnia. Aside from the fact that the high frequency current generated from a static machine is not accessible from one’s bedroom, its value as a calmant is doubtful. Occasionally the high frequency current has been known to bring on drowsiness but the evidence is just as conclusive that it excites quite as frequently as it soothes.