Causes

There are cases of sleeplessness that do not require dietetic treatment; there are others that can be cured by it; and some in which it is an important aid to medicinal treatment.

During sleep glandular functions are less active than during waking hours. The strong and active do not become drowsy after meals. Indeed, sleep is usually not sound and is sometimes impossible until digestion is partly completed. In general it may be said that at least from two and one-half to three hours should elapse between supper and bedtime. When the stomach is full and digestion is most active, sleep cannot be had or is much disturbed. The same thing is true when digestion is very slow or the evening meal has been a heavy one, even if two or three hours elapse between supper and bedtime. An exception to this general statement is found in the aged and the feeble, who often feel drowsy after meals. They may doze immediately after eating, but they rarely sleep soundly. The sudden need of much blood in the abdominal viscera to promote digestion depletes the cerebral vessels and disposes them to sleep.

In some cases sleep occurs during the first two or three hours after retiring and is then followed by wakefulness. Often this is due to slow digestion, active churning movements not developing until several hours after eating. In these cases also acid or other fermentation occurs the product of which cause gastric or intestinal unrest or distention but not necessarily pain. Frequently discomfort is so slight that it is unnoticed unless the patient's attention is directed to the observation of feelings in the abdomen during the hours of wakefulness.

Insomnia is very persistent and troublesome when a good state of nutrition is not maintained. Malnutrition and an excitable nervous system make many neurasthenics sleepless.

Treatment

When, in a person who is well nourished, sleep is disturbed and brief, and digestion is slow or poor, it is best to leave a considerable interval between the last hearty meal of the day and bedtime. The hearty meal should come at noon or at least not later than five in the afternoon. In the evening a light meal may be eaten - a sandwich with fruit, or a glass of milk, or bread and milk, or other simple foods in small amounts. In such cases all the meals should be of very moderate size and simple. Both by adjustment of diet and by exercise and relaxaton the digestive disorder should be corrected.

Late and very large meals must be avoided by those who are inclined to be sleepless, for gastric distention, whether by food and drink, or by gases resulting from indigestion, often causes sleeplessness. Frequently sour stomach also will interfere with sound or prolonged sleep. As the drinking of wine and beer, as well as the eating of rich food, is likely to cause this condition, the necessity of forbidding alcohol and rich food to such patients is self-evident.

Neurasthenics often obtain relief from the forced feeding of the rest cure. In mild cases a glass of warm milk or a cup of warm bouillon and a few crackers at bedtime promote drowsiness and, being quickly digested, will not disturb sleep. When there are great inanition and sleeplessness, food should be of the simplest kind and given often, so as to promote strength and increase flesh. A milk diet, supplemented gradually by a variety of nutritious and easily digested foods, is usually the best.

Many persons cannot drink tea and coffee at night without having sleep prevented or broken. This is so generally true that their use at night must be forbidden. Tobacco acts in the same way occasionally, but much less frequently than do tea and coffee.

Relief from business or other worry, and diversion from mental work or preoccupying cares, are as essential to the successful cure of insomnia as dietetic changes. Travel, a change of occupation, in mild cases games and reading at night, the lightest kind of unexciting literature, will often afford the needed diversion. Regular habits, regular times for work, for relaxation, and for sleep are necessary to prevent insomnia in certain persons.