Insomnia; and Other Disorders of Sleep

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epair of the tissues of the body. The great function of nutrition suffers as a consequence, and the patient rapidly falls into a condition of premature old age. When this takes place as a result of some temporary error of hygiene, or as a consequence of diseases which admit of successful treatment, the patient may be restored to health by judicious management, but lost youth and elasticity of the tissues can never be fully regained. The most formidable cases of insomnia are those for which no adequate cause can be recognized in the habits, mode of life, and state of health of the patient. Grave and permanent diso

y a position of great honor in the armamentarium of such people. Recognizing the fact that changes in the force of the circulation accompany and sustain every change in the activity of the cerebral cortex, we, however, attach the greatest importance to the condition of the nervous substance itself. For a clear understanding of the proper mode of medication, it is important to ascertain whether the cerebral substance is in a state of normal activity, or whether it is in a state of healthy, but excessive, activity, or whether its seeming excitement is merely the result of irritable wea

t, baths, and counter-irritants. Like all nervous stimulants, they promote the complete and harmonious action of all parts of the nervous system, favoring that equilibrium of the circulation which is most favorable to the development of sleep. The second class of agents comprises all such remedies as act directly upon the nervous tissue of the brain, depr

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S STIM

on of a nervous stimulant. This does occur, but only indirectly, and as a consequence of a restoration of energy to those

e chilliness, it tends to equalize the circulation of the blood, and produces throughout the body a ne

ture-this is better than any exact figure upon the scale of a thermometer-and the bath should not last lounger than ten minutes. Similar baths exercise a happy effect upon adult patients who are moderately feverish, nervous, and wakeful. If strong enough, they may take a f

pious perspiration induced by the heated air of the hot chamber is depurative, while the cold douche and the massage with which the bath is concluded have a powerfu

fecting all these processes nothing has yet surpassed the Sandwich Island lomi-lomi as practised by the court-retainers of the ancient chiefs. As a means of relieving fatigue, and of removing muscular soreness, after violent exertions of every kind, it is far superior to the imitations performed by European and American professional masseurs and masseuses. Nervous headaches, the pains that accompany spinal irritation, and all conditions of restlessness and wakefulness which depend upon exhaustion are relieved by this method. The well-known soothing influence of a mother's hand stroking the face and forehead of her sleepless child, is an example of only one of the effects thus produ

galvanic or faradaic, through any portion of the body often produces a temporary feeling of sleepiness; but the long continued employment of electricity is needful to effect those changes in cerebral nutrition which are necessary for a permanent cure of insomnia. In cases of sleeplessness caused b

n presented; notably a most ingenious argument by Dr. T. Lauder Brunton[40] in favor of the theory of inhibition by interference of vibrations-impulses from the periphery interfering with vibrations originating in morbid conditions of the central nervous organs-very much as darkness is produced by the

ay be profoundly influenced; pain may be annulled, and sleep be procured. The circulation of the blood is so powerfully affected by these measures that their good effects are usually attributed to the circulatory changes thus produced. But, as in all other modifications of the circulation, the nervous tissues and the vascular channels must first be reached by influences u

leepless agitation is often encountered during the later stages of exhausting diseases; and, if not properly treated, it soon leads to a fatal termination. The most important remedy for such distress is found in food. This must be soluble, diffusible, stimulant, and nutritive. Milk, alcohol, eggs, and meat-juice, are the typical representatives of such food. Milk should be as fresh as possible, and should be slightly salted, in order to hinder the formation of hard curds

entral Asia, and it is highly esteemed among the Russians in the treatment of pulmonary consumption. It is useful in all diseases affecting the digestive organs, and can often be tolerated, even by very young children, when nothing else will remain in the stomach. Considera

at a temperature of about 72° F., till it begins to curdle. Then stir in half a cupfull of pulverized coffee sugar, and cork tightly in champagne bottles with the best velvet corks. The bottles should be kept quite cool, as fermentation proceeds very briskly, and will break the containe

failed. When the stomach is very intolerant, it should at first be taken in very small doses, repeated as o

ed, beaten up with milk to which a small quantity of wine or spirits and sugar have been added. A glas

possesses considerable energy as a stimulant. Meat juice, therefore, occupies an important place as an excitant of those functions which must be aroused in order to secure the proper digestion of other articles of food. It should, therefore

night without taking some form of light and easily digested food. A simple slice of bread, or a

It has also been highly recommended in delirium tremens. Administered in the form of an infusion, it has been given in doses of a tablespoonful, every four hours, with apparently good effect.

t nervous tranquility which favors the incidence of sleep. It may, therefore, be advantageously associated with opiates in the restlessness and insomnia of exhaustion. Tull

ltus tendinum, mild muttering delirium, floccitation, musc? volitantes, and hiccough, with a small, frequent, tremulous or irregular pulse, without coma and without collapse. Under these circumstances musk tends to produce refreshing sleep, while it calms muscular spasm and favors perspiration, while the pulse grows fuller, more regular, and less frequent.... In p

hich women are liable during the "change of life." That form of restlessness, usually resulting from fatigue, in which the patient feels as if she cannot sit still, is often relieved very promptly by the valerianate of a

may be advantageously associated with opiates, or with hyoscyamus or belladonna in cases which do not easily tolerate the preparations of opium. The tannate of cannabin, given in doses varying from five to ten grains, has been recommended as an hypnotic; but, like the extract from which it is derived, its effects are rather uncertain. The pure alkaloid, cannabin, has

s been medicated with belladonna. Neuralgia, especially the form that involves the head, face, and intercostal nerves, is greatly mitigated by the use of belladonna, or its alkaloid, atropia. Its association with opiates seems to increase their hypnotic effect, while at the same time neutralizing their disagreeable action. According to Curci,[41] it opposes the tendency of opiates to cause cerebral hyper?mia. For this reason it is generally advisable to combine sulphate of atropia with sulphate of morphia for hypodermic use. Of t

anodyne. Sleep is produced only by the use of the drug in large doses, which also tend to excite delirium, sometimes even reaching to the height of maniacal fury. Children tolerate hyoscyamus in doses proportionally larger than can be taken by adults. By many physicians it is considered the hypnotic par excellence for children. In the various forms of insani

n that affection. For the relief of bronchial spasm the smoke of the dried leaves should be inhaled in considerable quantity. It may be smoked in a pipe; or, mixed with saltpetre, it may be made to smoulder upon a tin plate, while the smoke is drawn by inspiration into the lungs. Various kinds of

of the voluntary muscles on exertion." In minute doses, it is true that phosphorus acts as an irritant of nervous tissue. It promotes destructive changes in the tissues of the body, and thus produces a temporary excitement which may fa

larly diluted. It has been asserted, on theoretical grounds, that lactic acid and the lactate of sodium are directly hypnotic, but its experimental use has never given satisfactory results. Phosphoric acid has been used in the same way, with very similar effects. An impure solution of phosphoric acid, known as Horsford's Acid Phosphate, has been extensively used for its supposed hypnotic properties. It assists digestion, stimulates the kidneys, and by its general diffusion promotes molecular activity throughout the body. It is thus indirectly beneficia

S SEDA

ion of conditions favorable to sleep. We may now pass to the consideration of a class of remedies which operate more directly upon t

agency of baths and local refrigerants. A full account of the theory and practice of hydrotherapeutics can be found in the second volume of Von Ziem

othe "an irritable restless state of the nervous system." It should be employed once or twice a day, fr

eat benefit to the patient. The preferable method is the one advised by Von Ziemssen and Immerman. The patient is placed in a tub of water at 95° F. This is very gradually cooled down, in the course of half an hour, to 60° F. The bath should

the cold wet sheet. In order to humor the prejudices of the laity, this should be wrung out of warm water and applied with sufficient deliberation to insure its considerable loss of heat. A blanket should first be spread upon an empty bed; the wet sheet should be spread over the blanket. The patient must be placed naked upon the sheet, which should then be drawn around the entire body, and the blanket may be folded around the whole package. Children generally in

in, before he seized the pitcher, and began to drink from it. He was permitted to completely slake his thirst, and then the affusion was resumed. After four or five gallons of water had been thus poured over him, he was wiped dry, and was returned to his bed, where he immediately turned upon his side, and fell into a peaceful sleep. A few more affusions relieved him from danger, and he made a rapid recovery. Were people

ing protoplasm below the degree requisite for the excitement of consciousness. This sedative effect is preceded by a brief period of cerebral exaltation, occasioned by the disturbances caused by the first introduction of the drug into the current of the circulation.[42] It is with the subsequent hypnotic effe

ether, arouse the nervous system more thoroughly and agreeably than the pure alcoholic stimulants. Beer and porter are rendered more powerfully narcotic by the active principle of hops which they contain. The nutritive substances held in solution by these l

in the venous channels. Under such conditions the patient is usually delirious, tossing from side to side, and quite deprived of sleep. An ounce of brandy, repeated at intervals varying according to the severity of the symptoms, and given with milk and egg, in the familiar form of eggnogg, will often quiet this harassing restlessness, and will pro

sleep may be procured. It is in such cases advisable to combine the administration of capsicum with that of alcohol. According to

euralgia may thus be temporarily suspended. In like manner the "rheumatic" pains which afflict the overworked and underfed poor ma

of small doses of alcohol and ether. Under their influence the digestive fluids are more abundantly secreted, and all the bodily functions are quickened. Such good results, however, only follow the moderate use of the stimulant. It must never be taken in quantity sufficient to affect the intellectual functions, or to disturb any of

d only be sufficient to produce a uniform and general vascular relaxation. By this means the circulation is equalized throughout the body, and the brain passes into a state of tranquil sleep. Any excess

he proportion of one part in eight or nine of water. It may be used internally in doses varying from forty-five to one hundred and sixty grains. A watery solution,

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estimony is in its favor as an hypnotic in all cases, uncomplicated with disease of the stomach, in which insomnia is not dependent upon pain, and is associated with cerebral hyper?mia. Its administration is followed by no unpleasant consequences. Among the insane it is particularly recommended during periods of excitement and wakefulness. It has been employed with great satisfaction[44] in cases of insomnia during the course of such varied diseases as emphysema, bronchitis, phthisis, nervous and spinal disorders, diseases of the heart, jaundice, chronic rheumatism, and insomnia from other unrecognized causes. Undoubtedly, with greater skill in its purification and exhibition, it will become one of the most valuable of hypnotic remedies. Almost useless for the relief of pain, it is indicated in cases of uncomplicated insomnia. Having very little power, in moderate doses, t

ble in the treatment of those forms of insomnia associated with nervous irritability and hysteria. For the relief of wakefulness dependent upon a languid circulation, with cold feet and flatulence, the anodyne may be given in half-drachm doses well diluted with ice water, and repeated every fifteen minutes till relief is o

a remedy which is useful in all cases for which the compound spirit of ether is usually prescribed. In this form it is an excellent addition to various mixtures designed for the relief of spasmodic coughs by which sleep is disturbed. Ringer recommends it in the treatment of the irritative cough so characteristic of fibroid phthisis. It should also be used in cases of sp

ntal application or excitement of feeling, or accompanies the general debility following acute diseases attended with delirium or severe pain, or is associated with acute mania, especially of the puerperal form. The somewhat analogous condition which exists in delirium tremens is very amenable to this medicine, especially in the forming stage of the affection known as 'the horrors,' and which so frequently follows surgical injuries in drunkards; it is useful also when great nervous excitement and restlessness are associated with extr

re sleep, it may be followed at the expiration of an hour by a second dose of twenty grains. This seldom fails to induce refreshing sleep. When the medicine cannot be t

icrania. As an hypnotic it is seldom used. For this purpose it may be given in a solution like that of chloral hydrate. For a simple anodyne effect the medicine may be given in five-grain doses, repeated every half hour or hour. As a means of procuring sleep it may

aled in the form of vapor, from a handkerchief upon which five drops have been poured. The quantity will need to be gradually increased, as the system becomes tolerant of its effects. The stimulant effect of the medicine renders its use in this manner probably less dangerous t

other to idiosyncrasies on the part of the individuals subjected to experiment. The soporific effect of the drug appears to result from its direct action upon the substance of the brain. Under its influence the blood tends to accumulate in the veins, and loses its bright arterial hue. Small doses are said to contract the capillaries of the body, while they are

though the soporific properties of opium are chiefly due to the morphia which it contains, there are certain points of difference between the action of the two medicines that often render a choice desirable. According to Stillé and Maisch,[48] morphia does not stimulate circulation and the nervous system as much as opium, and its narcotic effects are less decided and speedy, though its after ef

tituted the principal agents in the treatment of insomnia. Even at the present time they are indispensable for the relief of all forms of sleeplessness d

ven at three o'clock in the afternoon in order to induce sleep at nine o'clock in the evening. As the effect of opiates is highly stimulant to the sweat-glands, and is often productive of nausea, it is advisable to associate atropine with morphine when thus given. For an adult the hundredth of a grain of atropine may be given with every quarter of a grain of morphine. The soothing and agreeable effects of morphia are thus intensified, while its disagreeable tendencies are reduced to a minimum. The injection should be made into the loose areolar tissue between the skin and the muscles. Its location is a matter of little importance so far as the relief of pain

e majority of painful or spasmodic diseases. If the patient be violently excited, the opiate should be combined with small doses of tartar emetic, ipecac, or tincture of aconite. But in the chronic diseas

f morphine. It is expensive and not very efficient, but may be sometimes prescribed w

ry little value. Its fluid extract is sometimes prescribed at night

mond praises calcium bromide. Hydrobromic acid is also employed as an hypnotic in certain cases. As a clinical fact the bromides of sodium and potassium are most frequently employed for the relief

they act to diminish reflex excitability. Under their influence the receptivity and functional capacity of the brain is reduced. Th

. Almost useless in cases marked by active congestion of the brain, they are invaluable in the insomnia produced by excessive mental exertion, care, emotion, worry and fatigue. The wakefulness of hysteria, of asthenic mania, and of sexual excitement, is often greatly relieved by the administration of the bromides. The prodromic stage of delirium tremens, before any violent outbreak, and the wakefu

disagreeable taste, it is not an eligible preparation. Lithium and calcium bromides may be given in scruple doses every hour o

the bromides only increase wakefulness. In such cases

of irritability of the bladder and sexual organs; in dyspepsia caused by irritable weakness of the stomach; and in the exhaustion of delirium tremens. The infusion is the best preparation for internal use. It may be taken in doses of one or two ounces, as required. Lupulin may be given in doses of ten gr

essed in acute mania. It has been employed in the treatment of delirium tremens; but the poisonous qualities of the plant render its use somewhat dangerous. The toxic effects are sometimes developed quite sud

t is so far reduced that other hypnotic remedies can produce their effect. For this purpose Squibb's fluid extract, in doses of about one-third of a drachm, or one-sixtieth of a grain of coniine, may be given sufficientl