Porridge and muscular relaxation: doctors discuss ways to get sound sleep – archive, 1954

Glasgow, Tuesday
After their business meeting, when for the most part they discussed how to make money by day, the doctors at the BMA meeting turned their thoughts to the problems of the night in the first of their scientific sessions here to-day. Their subject was sleep, but in this, the main problem appeared not to be that of sleep itself, but of how to get to sleep.

Rapidly it became obvious that staying awake and complaining about it was one of the more prevalent hobbies of the British. Insomnia, said Dr JO McDonagh, of Perth, was now “almost a fashionable disease or state.” And Professor DM Dunlop (Edinburgh) added that 10 per cent of all drugs now prescribed were barbiturates.

The discussion of why it should be so and what could be done about it ranged from fascinating glimpses of doctors sleeping soundly through air raids, “provided the bombs were dropping with sufficient regularity,” to the somewhat surprising danger for some of drinking a cup of tea before going to bed in the belief that it was only coffee that could keep one awake; and from the professor equipped with a suitcase of desert-island drugs to the recommendation of a plate of porridge as a good and effective nightcap.

By the end, the only conclusion the laymen could draw was that almost everything helped you to go to sleep and almost everything could keep you awake.

Rules of Sleep
There were rules about sleep, said Professor Sir Geoffrey Jefferson, of Manchester, but they had to be elastic enough to cover the whole of mankind, and how they applied to the individual no one knew better than the individual himself. For Sir Geoffrey the problem was really one of keeping awake, as the nervous system always seemed ready to “pack up”

This, however, was balanced by the statement that at present there appears to be no good cause why man could not always stay awake. The reason was, he said, likely to be a bio-chemical one. Everybody could stay awake for 36 hours “and some of us have done that, but after 36 hours staying awake produced increasing misery.” People kept awake for two or three days for investigations became quarrelsome and forgetful. “They forget what they have said and forget what you have said.” This was a method “much used in police stations for political purposes,” said Sir Geoffrey.

Largely it was a matter of education. There was no particular reason for sleeping at night except that society had been built up on seeing things in the light. Parents were well aware of the difficulties of teaching their children to go to sleep.

Whatever the reason for sleep, it was obvious that environment and conditions for it were most important. The “enormous increase” in the use of sleeping “or hypnotic” drugs was partly caused, said Professor Dunlop, by the stop-start method of living in modern cities, which, like the stop-start method of driving a car, was apt to be wearing on the mechanism. City dwellers appeared likely to turn consciousness on and off “like a tap.”

Not all stimuli kept one awake. There were for instance “sheep going through a gate, a great many wireless programmes, the lucubrations of after-dinner speakers” and, he added with an apologetic smile, “having to listen to speakers giving scientific papers.” Nowadays there were so many different barbiturate drugs that one could use “certain artistry in prescribing them.” Discussing the various hypnotic drugs he said that bromides were one of the group of drugs which could be discarded altogether. For himself, if he had to leave for the proverbial desert island he would take with him a suitcase containing one bottle of chloral “laced with a tincture of opium” in case he got pneumonia; a bottle of paraldehyde “in case I become a martyr to delirium tremens,” phenobarbitone for his anxiety neurosis, quinalbarbitone for “overnight use,” and butobarbitone for the “ultimate early-morning wakefulness of old age.” His audience could not but admire his preparedness.

Among all the customary causes of insomnia, Dr McDonagh found a new one – that of advertising. There must be many people, he said, who had had a slightly bad night and who would in a normal course of events have soon forgotten it. They were constantly reminded of the fact, however, on their way to work by advertising that “plugged” sleeping pills or some such on posters and in newspapers.

Warming to the attack, he added that everyone read that normal sleep was impossible unless on “such and such a mattress” or “on such and such a pillow” or “under so and so’s blankets.” What we tended to forget was that half the population of the world slept on the earth or on a hard bed without a pillow, or only a wood or china one, and under none or very few coverings. “And they sleep none the less soundly for it.”

Doctors could partly be to blame since the first question they often asked their patient was: “How did you sleep last night?” It was becoming uncommon to hear a person claim that he had slept soundly, and even more rare to hear a complaint that he was sleeping too soundly. It was a problem and a challenge to the general practitioner, and they should never accept the statement that the patient could not sleep and then just give them a pill or two. So many patients these days were “self-prescribers” of drugs.

There might not always be the time in crowded surgery hours but a little “unravelling” of the cause of sleeplessness could “work wonders,” and, more important, keep patients from starting on drugs. The establishment of a sleep routine was vital and in this, he commented, one night beverage had no greater effect than others of similar composition. For himself, be prescribed a plate of porridge. Nothing could be better, he said, than prayer at bedtime to get the person into the right frame of mind.