Insomnia is a problem that I often encounter in my clinical work. It may seem simple, but it is not, because insomnia is sometimes a precursor manifestation of a relapse or exacerbation of a psychiatric illness such as depression or schizophrenia, and sometimes it is the first manifestation of the illness. Correctly identifying insomnia and treating it accordingly can help greatly in the recovery of the disease. Of course, simple insomnia is also very common, and many times patients are afraid to use sleeping pills because they lack the appropriate knowledge and fear that they will become drug dependent, thus delaying timely and correct treatment and causing more pain to themselves and their families.
I wrote this article in the hope that we can understand insomnia, pay attention to insomnia, use the right medication, and ensure a better quality of sleep.
First of all, let’s understand the physiology of sleep.
Sleep is divided into eye fast-acting sleep (REM sleep, also known as fast-wave sleep) and non-eye fast-acting sleep (NREM sleep, also known as slow-wave sleep.) NREM sleep is further divided into four stages.
Stage 1 is light sleep, and
Stage 2 is moderate sleep.
Stages 3 to 4 are deep sleep.
When we fall asleep, we first enter non-eye fast-acting sleep, and then enter eye fast-acting sleep. One NREM sleep and one REM sleep make up one sleep cycle, and each sleep cycle lasts about 90 minutes. REM sleep duration and 3-4 stages of NREM sleep determine the quality of sleep. The majority of dreams appear in the eye fast moving sleep, that is to say, a night’s sleep we have to do 4-6 times of dreams, dreams normally account for about 20% of the whole sleep time, so that everyone has dreams, dreams at night are normal, but we often do not realize it.
Dreams have a very important role for the body: 1.
1, dreams help the recovery and strengthening of brain function.
2, dreams can bring pleasant memories (here refers to beautiful dreams).
3. Dreams can predict the occurrence of certain diseases.
4.Sleeping with dreams can prolong one’s life.
5) Dreams can increase a person’s creative thinking. 6) Dreams help stabilize a person’s mental state.
How long is it normal to sleep?
Generally speaking, the normal sleep time is 5-10 hours, children sleep longer, 9-10 hours or more, and adults sleep an average of 7.5 hours per night. About 1-2 people out of every 100 need only 5 hours of sleep per night, while a few others need 10 hours of sleep. Not everyone needs 8 hours of sleep, and less than 8 hours can be energetic, regardless of how much sleep is available, as long as it ensures daytime productivity and the energy needed, then sleep is normal.
What is the role of sleep?
1.Protect the brain and restore energy.
2.Enhance immunity and rehabilitate the organism: Sleep can enhance the ability of the organism to produce antibodies, while sleep can also speed up the self-rehabilitation of various tissues and organs.
3.Promote growth and development: sleep is closely related to children’s growth and development, infants and children continue to develop their brains for a considerable period of time after birth, and this process cannot be separated from sleep; and children’s growth increases at a faster rate in the sleep state, so children should be guaranteed sufficient sleep to ensure their growth and development.
4, delay aging, promote longevity: healthy and long-lived elderly people have a good and normal sleep.
5.Protect human mental health: poor sleep leads to inattentiveness, while long time can cause unreasonable thinking and other abnormalities.
Does insomnia mean short sleep?
Insomnia is defined as a condition of unsatisfactory quality and quantity of sleep that lasts for a long time, manifested by difficulty in falling asleep, frequent waking up during the night, early waking up and not being able to fall back to sleep, or not relieving tiredness after waking up. The length of sleep is not the key, the key is insomnia caused by daytime function, affecting the normal daytime activities, which is a necessary condition for insomnia.
Insomnia can be classified according to the duration of insomnia:
1, transient insomnia: insomnia time within 1-6 days, mostly due to stress, sleep environment change and other factors, most of them can relieve themselves.
2, short-term insomnia: insomnia lasting 1-3 weeks is called short-term insomnia.
3, long-term insomnia: insomnia lasts more than 3 weeks, the number of days of insomnia per week is more than 4 days, many medical diseases, psychiatric diseases, or bad habits can lead to long-term insomnia.
Insomnia can be classified according to specific performance:
1.Difficulty in falling asleep: difficulty in falling asleep refers to those who cannot fall asleep even after lying in bed for 30 minutes.
2, easy to wake up: easy to wake up refers to the two hours after going to sleep, the number of awakenings increases or waking time is prolonged. Usually the awakening time in sleep lasts less than 7 minutes, and when you wake up the next day, you cannot recall your awakening. However, frequent awakenings or excessively long awakenings can cause fatigue and irritability the next day.
3.Early awakening: Early awakening refers to waking up 1 to 4 hours earlier than normal sleep, resulting in less or insufficient sleep time. The cause is related to mental depression, depressed mood, etc. It is a characteristic insomnia of depressed patients.
Non-pharmacological treatment of insomnia.
1, the main method to correct insomnia is behavior adjustment and psychological adjustment, should not rely on long-term drug treatment.
2, to maintain an optimistic, contented and happy state of mind, social competition, personal gains and losses should be fully aware of, to avoid psychological imbalance due to setbacks.
3, moderate physical exercise during the day can help sleep at night, but avoid physical exercise 3 hours before bedtime.
4, 4-6 hours before bedtime to avoid caffeine and nicotine.
5, avoid the use of alcohol to help sleep.
6.Do not eat large amounts of food before bedtime.
7.Create a conditioned reflex mechanism conducive to sleep, such as taking a hot bath, soaking feet, drinking milk half an hour before bedtime.
8, to avoid excessive daytime sleep, appropriate short naps or snooze a few moments during the day.
9, regular work and rest time, going to bed at a fixed time at night.
10, after going to bed do not think about the daytime, work problems, avoid sitting in bed other activities, such as watching TV, talking, eating, reading, considering the problem.
11.If you can’t fall asleep quickly after lying in bed, you can get up and move around a little, and then go to bed when you feel like sleeping again, with the aim of making a conditional connection between bed and sleep.
12. Neither try to sleep nor try to control your thinking, just let nature take its course.
A, insomnia drug treatment
1, Valium drugs (benzodiazepines)
This class of drugs is familiar sleeping pills, but also the fear of addiction to drugs, its advantages are good sedative hypnotic effect, cheap, the disadvantage is that the side effects are large, such as waking up in the morning dizziness, muscle weakness, but also easy to cause a decrease in alertness during the day, can not be engaged in driving such work, long-term use of a large number of drugs easy to produce drug dependence.
Little common sense.
(1) Where the drug is followed by a certain diazepam or a certain zolam, are Valium-type drugs.
(2) drug dependence: including psychological dependence: deep inside the desire to take drugs, even if not, as long as the body has drugs will be very solid. Somatic dependence: Once you don’t take the medication, the original symptoms such as insomnia and irritability will appear again, as well as panic, nausea, sweating and other somatic symptoms.
If drug dependence occurs, generally speaking, patients will be taking larger and larger doses of medication, but the effectiveness of the medication is getting worse and worse, which is a sign of dependence. I often see patients who have been taking a certain kind of Valium for a long time, but the dose is not too high and the effect is very good, so I do not recommend that patients change their medication.
According to the duration of action of Valium drugs can be divided into.
1, short-acting drugs: the drug takes effect quickly, and the effect disappears quickly. The advantage is to solve the difficulty of falling asleep well, and wake up the next day with few side effects, the disadvantage is easy to produce drug dependence.
(1) Midazolam: commonly used dose of 7.5-15mg, 15-30 minutes before bedtime, recommended for short-term temporary use.
(2) triazolam: commonly used dose of 2.5-5mg, 15-30 minutes before bedtime, this drug can no longer be bought, discontinued.
2, medium-acting drugs: sedative-hypnotic effect is certain, the next day wake up side effects on the side, the advantages of anxiolytic effect.
(1) Eszopiclone (Scholastin): commonly used dose 1-3mg, 15-30 minutes before bedtime.
(2) Oxazepam: commonly used dose of 15mg-30mg, 15-30 minutes before bedtime, can also be 7.5-15mg temporary dose of anti-anxiety.
(3) alprazolam: (Jiajing Valium) commonly used dose of 0.4-0.8mg, 15-30 minutes before bedtime. Can also 0.4mg temporary dose of anti-anxiety.
(4) lorazepam: (lorazepam) commonly used dose 1-2mg, 15-30 minutes before bedtime. Can also 0.5-1mg temporary dose of anti-anxiety.
3, long-acting drugs: the advantage is the strongest sedative-hypnotic effect in the Valium class of drugs, the disadvantage is that the side effects are large.
(1) clonazepam (clonazepam): commonly used dose of 2-4mg, 15-30 minutes before bedtime. Dizziness and body weakness are easy to occur during the day. The strongest drug effect and the greatest side effects.
(2) Nitrazepam (nitroprusside): commonly used dose of 5mg-15mg, taken 15-30 minutes before bedtime.
(3) Diazepam: (Valium) commonly used dose of 5-10mg, 15-30 minutes before bedtime.
The principles of the use of tranquilizers.
(1) the principle of intermittent dosing: 2-4 times a week, can be used without drugs, not long-term large amounts of medication.
② the principle of the minimum effective amount: small doses work without large doses
③The principle of regular change of medication: If the condition requires long-term use of Valium, it is recommended to change to another Valium or third-generation sleeping medication in 3-4 weeks, which can effectively avoid dependence. Note that when changing medications, the original medication should be slowly reduced, and the new medication should be slowly added, usually once every 3-5 days, and half the amount of medication should be reduced at a time. After a period of cross-taking the two drugs, withdraw the original drug and add the new drug to the treatment amount. If the patient is taking a short-acting Valium, the reduction process will be extended accordingly.
If the patient is older, the dose of medication is not large, and the efficacy is better, you can also not change the medication, as long as the dose of Valium drugs taken does not increase, within the normal range, and the efficacy does not diminish, the patient is considered to be in need rather than dependent.
Second, the third generation of hypnotic drugs
With hypnotic effect, no sedative, anticonvulsant effect, can improve the sleep structure, but does not affect the normal physiological sleep structure, the first-line drugs for the treatment of insomnia. It has a short half-life, does not produce accumulation, has few after-effects, and has a mild effect on daytime. Generally does not produce rebound insomnia, drug resistance and dependence.
1. Zolpidem: commonly used dose 5-10mg, taken 15-30 minutes before bedtime. daytime
2 Zopiclone: commonly used dose 7.5-15mg, taken 15-30 minutes before bedtime.
3, Zaleplon: commonly used dose 5-10mg, taken 15-30 minutes before bedtime.
4, eszopiclone: commonly used dose of 3-6mg
Third, other drugs to improve insomnia.
1, antipsychotic drugs: olanzapine 5-10mg, quetiapine 50-200mg, suitable for schizophrenia or depression patients, simple insomnia patients are not recommended to take.
2, antidepressants: mirtazapine 15-30mg, trazodone 50-100mg, and amitriptyline 25-50mg, doxepin 50-75mg, etc., suitable for depression patients, insomnia patients can also take, no dependence, but amitriptyline tablets, doxepin side effects.
3, antihistamines: itself is an anti-allergy drugs, side effects are hypnotic, basically no dependence, commonly used is promethazine 25-75mg.
4, melatonin: is a kind of hormone, is considered a health product, sold very hot brain platinum is this thing in effect, only suitable for mild insomnia.
5, proprietary Chinese medicine: suitable for mild insomnia, there are Wu Ling capsule, Xin Shen Ning, seven leaves of Shen An tablets, Zao Ren An Shen Liquid, Lu You Tai, Sweet Dreams capsule, An Shen Tonic Heart Pill, septic tablets, Pao Zi Yang Xin Pill, Zhu Sha An Shen Pill and so on.
Fourth, the choice of drugs for different types of insomnia.
1, difficulty in falling asleep: choose drugs with fast sleep-inducing effects, most of which are drugs with short half-life, such as zaleplon, zopiclone, zolpidem, etc.
2, the presence of obvious anxiety: choose lorazepam, oxazepam, alprazolam and other drugs.
3, easy to wake up at night: choose drugs that can prolong NREM sleep stage 3 and 4 and REM sleep time, such as zopiclone, nitrazepam, clonazepam, etc.
4, early awakening: Mostly seen in depression, while treating the primary disease, you can choose medium and long-acting drugs, such as clonazepam, nitrazepam, diazepam, etc., isoprostanes can also be used.
If the patient’s insomnia is secondary to depression, schizophrenia and other diseases, you can consider antipsychotic drugs, antidepressants to take.
As for which medication is appropriate for each patient, the decision should be made after considering both the patient’s condition, previous medication experience, the effect after taking the medication, the patient’s drug tolerance, side effects, and the patient’s economic situation. By following up with the patients and adjusting the treatment plan at any time, the patients can gradually move towards recovery and let smiles bloom on the face of every family member.