Insomnia

INSOMNIA (agrypnia), a condition manifesting most often in that the subject cannot fall asleep for a long time, or awakening occurs significantly earlier than the usual time, and sleep is interrupted several times during the night. The causes of insomnia are often diseases of the respiratory tract with attacks of coughing and dyspnea, cardiovascular diseases, with high and low blood pressure, various disorders of the functions of the gastrointestinal tract (in children, with Oxyuris vermicularis), certain skin diseases (pruritus), abuse of strong tea and coffee, etc. Often, insomnia is a consequence of overwork, especially in individuals leading a sedentary lifestyle; in cases of prolonged insomnia, one may suspect some kind of mental illness, manic-depressive psychosis, obsessive psychoneuroses (fear of not falling asleep), drug addiction (morphinism), etc. Episodically, insomnia is observed in various neuralgias. Insomnia continuing for several months is observed in epidemic lethargic encephalitis. Insomnia in children with a neuro- and psychopathic constitution deserves attention, especially at the age of 14-15, with girls suffering from insomnia twice as often as boys. Encountered as a symptom in various somatic and neuropsychiatric diseases, insomnia does not require special therapeutic measures, except for prophylactic ones and treatment of the underlying affliction; only in the case of a protracted nature of insomnia is it necessary to resort to physical methods of treatment, various hypnotics, and psychotherapy. With an insufficient amount of bodily movement, physical culture and light sports can be of help, but not in the evening hours; sometimes electrotherapy in the form of a static shower and lukewarm baths at 30-32°, lasting 1/2 to 1/3 of an hour, are used with success. Consuming a heavy meal before sleep and evening stimulating activities are considered harmful. Among hypnotic agents, veronal, medinal, luminal, adalin, and sometimes preparations of bromine and valerian are prescribed. If there are complaints of various pains, pyramidon, phenacetin, dionin, etc., can be added to the hypnotic agents. According to the site of primary pharmacological action, hypnotics, according to Pick, can be divided into: a) cortical hypnotics, such as, for example, paraldehyde, chloral hydrate, and bromine; b) hypnotics primarily acting on the brainstem, to which belong veronal, luminal, chloretone; and c) hypnotics with mixed action, such as, for example, morphine and scopolamine. A combination of various hypnotics ensures a reliable therapeutic effect. Lit.: Schweisheimer W., Schlaf u. Schlaflosigkeit, München, 1925; Traugott K., Nervöse Schlaflosigkeit u. ihre Behandlung, Lpz., 1923. A. Kapustin.