The cause of primary insomnia being discovered and remedied by strict obedience to the violated health law, the conditon may be expected to gradually pass away without drugging, unless a confirmed habit of sleep lessness has become established. There are minor aids which in such cases should not be despised before resorting to hypnotics.
Thus change of scene, a sea voyage, free open-air exercises near the sea, indulged in till a decided degree of fatigue is felt, the avoidance of all mental overwork, and, as far as possilbe, of anxiety and worry, should be advised. A long, smart walk just before bed-time is an excellent hypnotic, if the patient upon finishing it retires immediately to his room, undresses without sitting down, and goes to bed.
Cold feet must be warmed and rubbed till tingling is produced. Robust patients can dip their feet for a few seconds into cold water, and restore the local circulation by having them rubbed briskly with a coarse towel. Feeble folk must generally fall back upon night socks and the objectionable hot-water bottle. Cold-water bandages to the forehead or scalp seldom do much good, and may keep the patient awake by causing discomfort locally. A hard bed is better than feathers, and a hop pillow may have a good moral effect. Where the patient tolerates it, elevation of the bed's head is a decided advantage, especially where there is want of vascular tone. Some fancy that they can sleep better when their bed is placed due north and south.
Various plans are recommended for wearying the brain, such as counting up numbers, repeating poetry, &c. The influences of monotonous noises or vibrations to which the patient has been long familiar, as the hum of city traffic, the sound of machinery, of running water, &c., are often productive of good. The writer knew of an instance of protracted and dangerous insomnia in the wife of a blacksmith, which, after failure of all hypnotics and absolute stillness, yielded to the music caused by the loud hammering on an anvil in the forge beneath her bedroom. He has witnessed an hospital patient who could not sleep till she got a small and rather noisy clock from her home and placed it by her bedside. It is as common an experience for sleep to become less sound in individuals who have slept for years in the centre of a noisy city after they move into peaceful suburban districts as in the opposite change from silence to noise.
A large warm or a cold-water draught before lying down occasionally soothes some patients. The habit of reading oneself to sleep by the aid of some uninteresting author, though not to be recommended, is often efficacious. The absence of light is generally essential, and the morning sun should be shut out by double blinds.
Massage is a powerful hypnotic, and sometimes very wakeful and neurasthenic patients fall asleep during the performance of it. Sometimes, however, massage may excite. Eccles advises thorough rapid massage of the abdomen, thighs and legs, so that a temporary anzemia of the brain may be produced by the blood flowing into the dilated vessels of the manipu lated regions. A warm or hot compress to the abdomen tends to prolong the dilatation of the abdominal bloodvessels, and sound, refreshing sleep often supervenes.
Hydropathy is occasionally valuable, and in some cases gives permanent relief. A warm bath should be taken till the patient is almost beginning to feel weak. He may then be enveloped in a flannel bath-sheet, and when lying on his bed upon the top of the bedclothes his body should be persever ingly rubbed down by an attendant with a linen Turkish towel till a grateful sense of drowsy languor is felt, after which he should get under the bedclothes. The Wet Pack may be employed for 45 minutes with advantage, but it will he better to use a sheet wrung out of tepid or warm instead of cold water, as generally recommended. Friction with a rough warm towel should be afterwards employed, and the amount of over-cloth ing should not be such as to encourage profuse perspiration, which may keep the patient awake. The local pack to the. trunk may likewise be employed with advantage, and after getting to bed its good effects may be kept up by giving a hot drink. Ge]lhorn uses a piece of calico, 18 inches wide and nearly 3 yards long, rolled up like a bandage, and a third of it wrung out of cold water. With this he bandages the leg, the wet portion being carefully covered up by several layers of the dry part as well as by a layer of gutta percha tissue, and a stocking drawn over the whole; the dilatation of the vessels which follows diminishes the amount of cerebral blood and induces sleep, especially where there is any cerebral congestion. The Cold Douche is valuable in allaying the cardiac excitement upon which the insomnia may depend.