_In which we lose our dread of night._
THAT INTERESTING INSOMNIA
THE FEAR OF STAYING AWAKE
To sleep or not to sleep! That is the question. In all the world there
is nothing to equal it in importance,--to the man with insomnia. His
days are mere interludes between troubled nights spent in restless
tossing to and fro and feverish worry over the weary day to come. His
mind filled with ideas about the disastrous effects of insomnia, he
imagines himself fast sliding down hill toward the grave or the
insane-asylum. It is true that his conversation very often politely
begins something like this: "Good morning. Did you sleep well last
night?" but if we fail to respond by an equally polite "and I hope you
had a good night?" he seems restless until he has somehow
disillusioned us by stating the exact number of hours and minutes
during which he was able to lose himself in slumber.
We must not ridicule the man who doesn't sleep. We are all very much
alike. If any one of us happens to lie awake for a night or two, he is
likely to get into a panic, and if the spell should last a week, he
begins looking up steamship agents and talking of voyages to Southern
seas. The fact is that most people are dreadfully afraid of insomnia.
Knowing the effects of a few nights of enforced wakefulness, and
having had a little experience with the fagged feeling after a
restless night, they believe themselves only logical when they fall
into a panic over the prospect of persistent insomnia.
=Two Kinds of Wakefulness.= As a matter of fact, insomnia is a phantom
peril. There is not the slightest danger from lying awake nights,
provided one is not kept awake by some irritating physical stimulus.
All fear of insomnia is based on ignorance of the difference between
enforced wakefulness and deliberate wakefulness, or insomnia. The man
who has acquired the habit may stay awake almost indefinitely without
appreciable harm, but the one who is kept awake for a week by a pain,
by a chemical poison from infection, or by the necessity for staying
up on his job, may easily be in a state of exhaustion. Even in cases
of prolonged pain or over-exertion, the body tends to maintain its
equilibrium by hastening its rate of repair and by falling asleep
before the danger point is reached. It is almost impossible to impair
permanently the tissue of the brain except in the presence of a
chemical irritant. In case of infection we often have to give medicine
to neutralize the effect of the poison or to resort to narcotics which
make the brain cells less susceptible to irritation. But nervous
insomnia is another story.
A HARMLESS HABIT
=Long-Lived Insomniacs.= A man of my acquaintance once said in all
seriousness and with evident alarm: "I am following in the footsteps
of my mother. She lived to be seventy years old and she had insomnia
all her life." If this man had been preaching a sermon on the
harmlessness of chronic insomnia, he could not have chosen a better
text, but he seemed just as much concerned about himself as if his
mother had died from the effects of three months' wakefulness. People
can live healthy lives during twenty or thirty years of insomnia
because chronic insomnia is nothing more or less than a habit, and
"habit spells ease." The brain cells are not irritated by either
internal or external stimuli; there is no effort to keep awake;
virtually no energy is expended,--except in restless tossing and
worry. If the body is kept still and emotion eliminated, fatigue
products are washed away and the reserves are filled in with perfect
ease.
=Thinking in Circles.= Habit means automatic, subconscious activity,
with the least expenditure of energy and the least amount of fatigue.
We have already noted the ease with which heart and diaphragm muscles
carry on their work from the beginning of life to its end. Anything
relegated to the subconscious mind can be kept up almost indefinitely
without tire, and to this subconscious type of activity belong the
thoughts of a chronic insomniac. Despite all assertions to the
contrary, his conscious mind is not really awake. If he is questioned
about the happenings of the night, he is likely to have been unaware
of the most audible noises. The thoughts that run through his brain
are not new, constructive, energy-consuming thoughts, but the same old
thoughts that have been going around in circles for days and weeks at
a time.
It is true that a person sometimes chooses to wake up and do his
constructive planning in the night. This kind of thought does bring
fatigue, up to a certain point. After that the body hastens its rate
of repair or automatically goes to sleep. Activity of this kind is
always a matter of choice. He who really prefers sleep will shut the
drawers containing the day's business and leave them shut until
morning.
=Day-Dreaming at Night.= However, the man who makes a practice of
staying awake rarely does much real thinking. He lets the thoughts run
through his mind as they will, builds air-castles of things he would
like to do and can't, or other kinds of air-castles about the
disastrous effects of his insomnia on the day that is to come; he
worries over his health, or his finances, and grieves over his
sorrows. He is really indulging himself, thinking the thoughts he
likes most to think, and these consume but little energy. Like a horse
that knows the rounds, they can go jogging on indefinitely without
guidance from the driver.
WHAT CAUSES THE FATIGUE
=Tossing and Fretting.= The thing that tires is not the insomnia but
the emotion over the insomnia. If people who fail to sleep are
perpetually fagged out, it is not from loss of sleep, but from worry
and tossing. Often they spend a good deal of the night feeling sorry
for themselves. They turn and toss, exclaiming with each turn: "Why
don't I sleep? How badly I shall feel to-morrow! What a night! What a
night!" Such a spree of emotionalism can hardly fail to tire, but it
is not fair to blame the insomnia.
He who makes up his mind to it can rest almost as well without sleep
as with it, provided he keeps his mind calm and his body relaxed.
"Decent hygienic conditions" demand not necessarily eight hours of
sleep but eight hours of quiet rest in bed. Tossing about drives away
sleep and uses up energy. I make it a rule that my patients shall not
turn over more than four times during the night. This is more
important than that they should sleep. To be sure, I do not stay awake
to enforce the rule, but most people catch the idea very quickly and
before they know it they are sleeping.
HOW TO GO TO SLEEP
=Ceasing to Care.= The best way to learn to sleep is not to care
whether you do or not. Nothing could be better than DuBois's advice:
"Don't look for sleep; it flies away like a pigeon when one pursues
it."[58] Attention to anything keeps the mind awake, and most of all,
attention to sleep. More than one person has waked up to see whether
or not he was going to sleep. We cannot, however, fool ourselves by
merely pretending indifference. The only sensible way is to get the
facts firmly fixed in our minds so that we actually realize that we do
not need more sleep than our bodies take. As soon as it is realized
that insomnia is really of no importance, it tends to disappear.
[Footnote 58: DuBois: _Psychic Treatment of Nervous Disorders_, p.
339.]
=Catching the Idea.= There came one day for consultation a very
healthy-looking woman, a deaconess of the Lutheran Church. "Doctor,"
she said, "I came to get relief from insomnia. For twenty years I have
not slept more than one or two hours a night." "Why do you want more?"
I asked. "Why, isn't it very unhealthy not to sleep?" she exclaimed
in astonishment. "Evidently not," I answered.
This woman had tried every doctor she could think of, including the
splendid S. Weir Mitchell. Her insomnia had become a preoccupation
with her, her chief thought in life. All I did was to explain to her
that her body had been getting all the sleep it needed, and that
neither body nor mind was in the least run down after twenty years of
sleeplessness. "When you cease being interested in your insomnia, it
will go away, although from a health standpoint it matters very little
whether it does or not." We had two conversations on the subject, and
a week later she came back to tell me that she was sleeping eight
hours a night.
One woman had had insomnia for thirty years. After I had explained to
her that her body had adjusted itself to this way of living and that
she need not try to get more sleep, she snored so loud all night and
every night that the rest of the family began to complain!
A certain banker proved very quick at catching the idea. He had been
so troubled with insomnia and intense weakness that his doctors
prescribed a six-months voyage in Southern waters. Knowing that my
prescriptions involved a change in point of view rather than in scene,
he came to me. Although he had been getting only about half an hour's
sleep a night, he went to sleep in his chair the first evening, and
then went upstairs and slept all night. He resumed his duties at the
bank, walking a mile and a half the first day and three miles the
second. During the months following, he reported, "No more insomnia."
=Keeping Account.= A bright young college graduate came to me for a
number of ailments, chief among them being sleeplessness. She was also
overcome by fatigue, having spent four months in bed. A four-mile walk
in the cañon and a few other such outings soon dispelled the fatigue,
but the insomnia proved more obstinate. After she had been with me for
a week or two, I took her aside one day for a little talk. "Well?" I
said as we sat down. Then she began: "Sunday night I was awake from
half-past one to four, Monday from twelve to one, Tuesday from one to
three, Wednesday from two to four, Thursday--" By this time she became
aware of the quizzical expression on my face and began to be
embarrassed. Then she stopped and laughed. "Well," she said, "I did
not know that I was paying so much attention to my sleep." She was
bright enough to see the point at once, gave up her preoccupation in
the all-absorbing topic and promptly forgot to have any trouble with
so natural a function as sleep.
=Making New Associations.= Examples like this show how natural is
childlike slumber when once we take away the inhibitions of a
hampering idea. Age-old habits like sleep are not lost, but they may
easily be interfered with by a little too much attention. When a
person who can scarcely keep his eyes open all the evening is
instantly wide awake as soon as his head touches the pillow, we may be
sure that a part of his trouble comes from the wrong associations
which he has built up with the thought of night. When a dear little
old lady told me of her constant state of apprehension about going to
bed, I said to her: "When I go to my room, the darkness says sleep.
When I take off my clothes, the very act says sleep. When I put my
head on the pillow, the pillow says sleep." She liked that and found
herself able to sleep all night. The next evening she wanted another
"sleeping-potion" but as I did not want her to become dependent on
anybody's suggestion, I put my mouth up close to her ear and
whispered, "Abra ca dabra, dum, dum, dum." She laughed, but saw the
point. After that she slept very well. She merely broke the habit by
making a new kind of association with the thought of bed. Nature did
the rest.
It seems hardly necessary to remark that drug-taking is the most
inefficient way of handling the situation. Everybody knows that
narcotics are harmful to the delicate cells of the brain and that the
dose has to be continuously increased in cases of chronic insomnia.
If a person realizes that the drug is far more harmful than the
insomnia itself, he is weak indeed to yield to temptation for the sake
of a few nights of sleep. As the cause of insomnia is psychic, so the
only logical cure is a new idea and a new attitude of mind.
THE PURPOSE OF INSOMNIA
Like all nervous symptoms, insomnia is not an affliction but an
indulgence. Somehow, and in ways unknown to the conscious mind, it
brings a certain amount of satisfaction to a part of the personality.
No matter how unpleasant it may be, no matter how much we consciously
fear it, something inside chooses to stay awake.
Started, as a rule, through suggestion or imitation, insomnia is
sometimes kept up as a means of making ourselves seem important,--to
ourselves and to others. It at least provides an excuse for thinking
and talking about ourselves, and furnishes a certain feeling of
distinction. If something within us craves attention, even staying
awake may not be too dear a price to pay for that attention. Strange
to say, there are other times when the insomnia is chosen by the
primitive subconscious mind with the idea of doing penance for
supposed sins whose evil effects might possibly be avoided by this
kind of expiation. Analysis shows that motives like this are not so
uncommon as might be supposed. In other cases insomnia is chosen for
the chance it gives for phantasy-building. A person denied the right
kind of outlet for his instincts may so enjoy the day-dreaming habit
that he prolongs it into the night, really preferring it to sleep.
Such a state of affairs is not at all incompatible with an intense
conscious desire to sleep and a real fear of insomnia. So strange may
be the motives hidden away within the depths of the most prosaic
individual!
SUMMARY
Nervous insomnia is something which a part of us makes use of and
another part fears. It is a mistake on both sides. Although not in the
least dangerous, the habit can hardly be considered a satisfactory
form of amusement. Nature has provided a better way to spend the
night, a way to which she speedily brings us when we choose to let her
do it.
We do not have to ask for sleep as for a special boon which may be
denied. We simply have to lie down in trust, expecting to be carried
away like a child. If our expectation is not at once realized we can
still trust, as with relaxed mind and body we lie in calm content,
knowing that Nature is, minute by minute, restoring us for another
day.