I have given in the previous chapters many reasons why human beings are compelled to seek at regular intervals an escape from reality which is made possible by the unconsciousness of sleep.

Why is it then, that many people suffer from insomnia?

Many physical factors are generally mentioned as the direct causes of sleep disturbances. None of them should be dismissed as unimportant; nor should any one of them, however, be accepted as an exclusive and all-sufficient explanation of sleeplessness.

Coffee, tea and cocoa (the latter even in the shape of chocolate candy) taken in large quantities, particularly before retiring, affect our sympathetic or safety nerves. They make us, therefore, more sensitive to slight sound, light, pressure, smell, etc., stimuli, which under ordinary circumstances we would not notice consciously.

In other words, they create imaginary “emergencies” which require the usual preparation for fight or flight, that is, keen observation of our environment, arterial tension, etc., all conditions which make sleep impossible.

Yet we cannot say that coffee, tea or cocoa, without some other contributing cause would always bring about sleep disturbances.

Bleuler writes: “I had been in the habit of drinking every night several cups of very strong tea which never prevented me from sleeping. Since I have had the influenza, things have been very different. I must be careful not to partake of such stimulants before going to bed. But even then, their effect depends on my mental condition. They affect me more at certain times than they do at others. If I am the least bit excited their effect is increased. When I am perfectly relaxed, I may not feel any bad effects.”

A bedroom into whose windows flashes of light or waves of sound may pour, is the not ideal place in which to seek escape from reality. Yet thousands of people sleep soundly in Pullman berths or even in day coaches, unmindful of the noise, light and bustle.

We must keep in mind an observation made by Bleuler at the ZÜrich clinic:

“When many people sleep in the same room, as in an insane asylum, some complain that they cannot sleep because their neighbour is snoring. Whoever tries to prevent the snoring or to move the snorer to another bed will have an endless task. The trouble is with the patient who is disturbed by snoring. It is not the noise itself but the attention he pays to it which disturbs him. One can see in wards for agitated patients most of the patients sleeping peacefully while some one disturbs the ward with the most savage howling.

“The trouble lies, not in a special sensitiveness of the nervous system, but in the attitude we take toward a certain noise.”

Lack of exercise during the day will often cause us to toss and turn many times in our bed after retiring. There seems to be in every living being a craving for activity without any positive aim, activity which accomplishes nothing besides using up unused energy or relieving certain inhibitions.

Children and all young animals seem to be unable to remain motionless for any length of time. In children and puppies, for example, the gleeful shouts and barking which accompany that display of muscular activity show unmistakably that it vouchsafes them a great amount of gratification.

The satisfaction of the free activity urge which is one of the aspects of the ego-power urge is probably submitted to a strong repression in men and animals at a rather early age by the safety urge; frightened children and animals stop playing and become at times paralysed by fear.

On the other hand there are many sluggish individuals who lead an most inactive life and yet sleep long hours without any interruption.

Indigestion causes insomnia and so does hunger but it is also a fact that many indiscreet eaters are made drowsy by their very indiscretion and sleep soundly after a meal which would distress many other people. Also we find in the sayings of many races statements to the effect that sleep assuages hunger; the average prisoner sleeps in spite of the insufficient meal served at night in the majority of jails.

Constipation seems at times to bear the guilt for restless nights and so do cathartics which, with some subjects, produce intestinal tension several times during the night but whose effect is not noticeable in other subjects until they wake up in the morning at the regular time.

Toothache will keep some people awake while others will go to sleep in order to forget their toothache.

Examples of that sort could be cited ad infinitum.

In case of sleeplessness, the first thing to do is to remove all the possible physical causes which can be reached directly or with the help of a physician.Thyroid irritation for instance may at times make one more sensitive to even faint noises and a thorough medical examination should be undergone.

The dentature should be examined with the help of X-ray photography in order that pus pockets, impaction, and other defects, not observable with the naked eye, may be revealed and remedied.

The diet should be regulated so as to exclude indigestible foods while assuring, especially at night, sufficient nourishment.

All stimulants should be avoided.

A walk before retiring is very beneficial in all cases, not because it “tires” the subject, but because it absorbs the chemical products thrown into the blood for emergencies which did not arise in the course of the day. A long walk or any arduous exercise, on the other hand, might do more harm than good if they brought about the phenomenon of the second wind.

Any form of physical or mental exercise involving rivalry or competition is to be avoided at night. The excitement caused by the “fear of losing” would again fill the blood with “fight or flight” products. Heated discussions, the witnessing of exciting films or plays, drives with a daredevil chauffeur, etc., are not conducive to peaceful sleep.

When all those means fail, many devices have been offered to insomnia sufferers, such as prayer or counting sheep, reading, listening to some monotonous stimulus like the buzzing of a faradic inductor, or of an electric fan.

A distinction must be made between stereotyped prayer (such as the Lord’s Prayer) and personal prayer rehearsing one’s worries and asking for help. The latter kind is not unlikely to revive all the day’s problems and to set the would-be-sleeper solving them over again at the very time when he should forget them.

The repetition of some passage which was memorized in childhood and which, from long familiarity has become perfectly impersonal, may go a long way toward creating the monotony, and hence the feeling of safety, without which there cannot be any sleep.

After following all the rules I have laid down a number of people will still be unable to sleep. When the physico-psychic causes have been removed without improving the condition of the subject, the psychico-physical factors should then receive attention.

As I said before, normal people can sleep under almost any conditions because their vagotonic activities function regularly, while neurotics cannot sleep well even under ideal conditions because their sympathicotonic activities are constantly raising a signal danger and imagining emergencies amidst the safest surroundings, mental and physical.

The insomnia sufferer is suffering from some fear. That fear has to be determined and uprooted by psychoanalysis.

Some people cannot sleep because they have gone through a period of sleeplessness and expect it to endure for ever. The men of the Emmanuel movement often had the following experience: a subject would explain that he could not sleep under any circumstances. The Emmanuel healer would ask him to sit in a chair in which, he said, many people had fallen asleep, and after a few minutes of soothing conversation or concentration, the insomniac would doze off peacefully. In certain cases, such a cure may be permanent; in other cases, when the results are obtained through transference and suggestion, the help of the psychological adviser or hypnotist may be too frequently required.

Other subjects are prevented from sleeping by “worry.” Telling a careworn insomniac not to worry is as silly and useless as telling a lovelorn person to stop being in love.

Discussing a patient’s worries with him, however, often accomplishes much good, for it compels him to sift all his evidence, which may be convincing to him but to no one else. The worried person who is beginning to experience doubts as to the magnitude of his trouble, is like the patient suffering from delusions who has lost faith in his delusions.

The parasitic fears and cravings which attach themselves to some small worry and, at times, magnify it out of proportion, may in such a way be disintegrated and dissociated from the actual, justified fear.

Giving the patient “good reasons” why he should not worry, is again a sort of suggestion of the most futile and least durable type.

Obsessive fear which is at the bottom of every worry is due to certain complexes, at times apparently unrelated to the actual disturbance, and which cannot be unearthed and uprooted except by a thoroughgoing psychological analysis.

This is especially true of certain cases of insomnia which the patient reports as follows. “I fall asleep with difficulty and with a certain apprehension. I sleep an hour or two during which I have awful dreams which I cannot remember. After which I hardly dare to close my eyes again.”

This is what I would call the fear of the unknown nightmare, and the anxiety dreams responsible for it must be patiently reconstituted from the scraps which invariably linger in the subject’s memory, even when he imagines that he cannot remember any dreams. The procedure will be explained in the next chapter.

While the psychoanalytic treatment is being applied, however, the patient must be made aware of a fact which will comfort him to a certain extent.

Patients often fear that if their sleeplessness is not relieved “at once” they will “loose their minds.” Thereupon they beg to be given some narcotic.

We must remember that the results of sleeplessness depend mostly upon the attitude which we assume toward that condition. It may seem paradoxical to state that its bad results are mainly due to our fear of them but it is true nevertheless.

We assume that we shall be exhausted by a sleepless night. We go to bed in fear and trembling, wondering whether we will or will not sleep. That anxiety is sufficient to liberate secretions which produce an unpleasant muscular tension and a desire for activity. This keeps us awake until the chemical contained in those secretions have been eliminated. In the meantime, we develop a fit of anger which releases some more of the identical chemicals. After which we are doomed to many hours of unrest and agitation.During those restless hours we toss about angrily and exhaust ourselves physically. About dawn, when sleepiness generally overtakes even the most restless, we finally doze off and are awakened by our alarm clock or some other familiar disturbance and once more relapse into anger at the waste of our sleeping hours and the disability which we feel is sure to result from it.

We naturally feel worn out. If, on the other hand, we would resign ourselves to our sleeplessness, realize that rest, even in the waking state, will relieve our organism of all its “fatigue” and that, by complete relaxation in the waking state, we can liberate almost as many of our unconscious cravings as in the unconsciousness of sleep; if we were as careful not to waste uselessly our inner secretions as we are not to touch live wires, we would lie down as motionlessly as possible, and would consign to the scrap heap all the absurd notions as to the dire results of a sleepless night; we would then awaken in the morning as refreshed by the two or three hours of sleep that would finally be vouchsafed us as by the usual eight or ten.

The amount of sleep one needs varies with every individual and increases or decreases according to unconscious requirements. Hence, statements to the effect that one needs eight or ten hours’ sleep are absurd and dangerous.

Many people are worried over the fact that their sleep is irregular, that is, that they sleep six hours one night and ten the next night and possibly only four hours the third night.

This is probably as it should be. Our requirements vary with varying conditions. After eating salt fish one may need several glasses of water to slake one’s thirst, while one may not need to drink a drop of any liquid after partaking of juicy fruit.

One should also dismiss as an idle superstition the dictum according to which sleep before midnight is more beneficial than sleep after midnight. Hundreds of newspapermen, watchmen, policemen, printers, railroadmen, etc., work nights and sleep in the day time and do not contribute more heavily than other professions to the ranks of the mentally deranged.

Older people, whose urges are at low ebb and do not require the satisfaction vouchsafed by dream life should become reconciled to the fact that they need few hours sleep; they should refrain from taking narcotics and go to bed later than they do, so as not to “lay awake all night,” which generally means that after dozing an hour or two in an armchair and retiring at ten they wake up normally about one or two in the morning.

Sleep is important in health but even more so in mental disturbances. The solution for the complicated problems of the neurotic’s life depends upon the wealth of facts contained in the unconscious rising freely to the surface in dreams and relieving the uncertainty. The tragedy is that except in cases of sleeping sickness, the neurotic who needs more sleep than the healthy subject, generally gets much less.

The neurotic should sleep preferably at night and avoid day sleep. This for two reasons. He should keep in touch with reality when reality is active and obvious, as during the day. With the falling of the shadows, reality acquires a tinge of indefiniteness which lends itself to many misinterpretations and to fancies of the morbid type.

Sleeplessness in the ghostly hours of the night is a poison for the neurotic, for everything at such times is exaggerated, distorted and the slightest worry is transformed into a terrible danger. Many children could be spared fits of “night terrors” if they were not forced to go to bed very early, after which they are likely to wake up in the middle of the night, disoriented and fearful.

It has been said that insomnia was the cause of insanity and experiments such as those made at the University of Iowa show that men kept awake for a prolonged period of time begin to have delusions and hallucinations similar to those of dementia praecox. But it must be remembered that the men who submitted to those experiments were not allowed to “rest.”

The contrary proposition, that is, that insomnia is induced by insanity is more plausible psychologically.

And indeed every psychiatrist has made the observation that some insane people sleep very little, so little in fact that such protracted periods of sleeplessness would kill the average normal person. That observation has been confirmed by Bleuler, who as the head of the Zurich psychiatric clinic and one of the most tireless psychological experimenters in the world, is in a position to speak with authority.

Neurotics sleep very little, and the more severe their case is, the less they sleep. Return of normal sleep generally coincides with a cure and has been by many credited with bringing about the cure. Hence the many “rest cures” suggested for the mentally disturbed patient.

The truth of the matter is that the absolutely insane person who lives all his absurd dreams in his waking life no longer needs the unconsciousness which the normal individual requires in order to escape from reality. The insane man who knows he is a combination of a Don Juan, a millionaire and a powerful ruler, need not dream of becoming all those characters. He has attained his goal and it is only the continued conflicts with reality which may reach his consciousness in his lucid moments which necessitate the unconsciousness of a few minutes or hours of sleep in which reality no longer intrudes into his absurd world.

Since insomniacs can rest without sleep and insomnia does not lead to insanity, there is no reason why narcotics should be administered. There is a very good reason on the other hand why they should never be administered except in case some harrowing pain has to be relieved and shock avoided.

For one thing, their effect is problematic and depends also to a great extent from the subject’s mental condition.

Kraepelin noticed that large doses of alcohol failed to produce the usual muscular lameness in subjects who were agitated. Bleuler makes the interesting suggestion that our central nervous system only “accepts” narcotics when they are “wanted” and keeps drugs, carried about in the blood stream, from being assimilated by the organism when the organism is not “willing” to submit to their influence.

But the most cogent reason why narcotics should never be resorted to in “nervous” sleeplessness is that they do not relax the organism but paralyse it by killing it partly. If they only dulled consciousness and freed the unconscious, they would accomplish some good but we do not know of any agent besides sleep, which accomplishes that successfully.

Narcotics partly kill both consciousness and unconscious. While their effect lasts, the very phenomenon which makes the neurotic a neurotic is exaggerated. In the neurotic’s waking state, unconscious complexes manage to free themselves, somewhat indirectly. In the stupor of drugged sleep, the repression is complete. Hence the horrible feeling which is often experienced when awakening from drug-induced sleep. Normal sleep is brother to life, but drug induced sleep is indeed akin to death.

Neither can hypnotic suggestion be recommended as a cure for sleeplessness, except of course, in emergencies.

About the end of the nineteenth century, a Swedish physician, Wetterstrand, inaugurated a method of treatment which was founded on a just estimate of the value of sleep, although Wetterstrand himself could not at the time have understood the psychology of it.

He had in Upsala a “house of sleep” furnished with innumerable divans and couches on which his patients were allowed to rest for hours in hypnotic sleep.

Of course this procedure had two glaring defects: hypnotism is a neurotic phenomenon which should not be applied to the treatment of a neurosis and, secondly, sleep in the daytime is generally enjoyed at the expense of the night’s sleep.

At the same time, the sleep which patients enjoyed in Wetterstrand’s “Grotto of Sleep,” as it was called at the time, must have been of a somewhat curative kind; for the house was as silent as a grave. Thick carpets deadened all sounds and all the lights were dimmed. No stimuli were allowed to produce in the sleepers any fear reactions.

What Wetterstrand really supplied to his patients was an ideal bedroom and an opportunity for an absolutely uninterrupted sleep of several hours. We do not know, however, how many of them were robbed of the effect of such an ideal environment by the anxiety dreams which the quietest bedroom cannot exclude.

The conclusion to be drawn from what has been said in the preceding chapters is that the real mission of sleep is to free the unconscious, to relieve the tension due to repressions and to give absolutely free play to the organic activities which build up the individual.

Hence the goal is sleep of sufficient duration, sleep undisturbed by physical stimuli, sleep FULL OF DREAMS but FREE FROM NIGHTMARES.

No more potent curative agent could be found than that kind of sleep, whether the ills to be remedied are of a “mental” or of a “physical” nature. Not until all the fear-creating complexes have been disintegrated by psychoanalysis, however, can the insomniac hope to enjoy that perfect form of “rest.”