Insomnia; and Other Disorders of SleepLyman, Henry M. (Henry Munson)
Science
Insomnia; and Other Disorders of Sleep
Lyman, Henry M. (Henry Munson)
Dreams; Insomnia; Sleepwalking
Under ordinary circumstances morphia is the preferable opiate for the
relief of insomnia. The sulphate is most frequently employed, but the
acetate and the tartrate have been recommended on account of their
supposed superiority in the formation of solutions that are unirritating
and permanent in their character. The hypodermic method of administration
forms the most prompt and efficient mode of procuring the effect of the
medicine. It should be given in a dose of quarter of a grain about an hour
before the time when sleep is desired. For some patients a longer time is
necessary to develop its hypnotic effect. To children the hypnotic dose
must sometimes be given 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 is concerned; but the
neighborhood of the blood vessels should be avoided, since alarming
symptoms have been observed after injection into a vein. The outer aspect
of the arm near the insertion of the deltoid muscle is a favorite site for
puncture. If, for any reason, the hypodermic use of morphia cannot be
employed, it may be introduced into the rectum either in solution or in a
suppository. The bowel should first be washed out with an enema of warm
water; the opiate may then be introduced. The dose thus exhibited need
scarcely exceed that usually given by the mouth; but, if the rectum is not
previously cleansed, a double, or even triple, dose may be required.
As an hypnotic morphia is chiefly useful in phthisis, in cardiac dyspnœa,
in diseases of the stomach which cause insomnia, in fevers with
prostration and delirium, in delirium tremens, in mania, and in the
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 diseases it is
desirable to avoid its continuous administration, not only on account of
the risk of creating the opium habit, but also by reason of the injurious
effects of the drug upon digestion and nutrition.
_Codeine_ is a mild hypnotic which may be used in doses about twice as
large as those of morphine. It is expensive and not very efficient, but
may be sometimes prescribed with advantage when moral considerations
render the use of ordinary opiates inexpedient.
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