I. Brief description of sleep physiology
The occurrence and regulation of sleep is one of the unique functions of the brain, and involves changes in all aspects of the body, but the exact function of sleep is still not completely clear.
(A) The function of sleep
1.Promote the development of brain function and development
2.Preserve the energy of the brain and restore the function of the body
3.To consolidate memory and ensure the best function of the brain
4.Promote the growth of the body and slow down aging
5.Enhance the immune mechanism of the body
6.Protect the central nervous system
(B) Waking/sleeping rhythm
With the rotation of the earth and the alternation of day and night, human life activities will show obvious cycles, including waking, sleeping, eating, physical activity, vegetative nerve function, various mental functions, work efficiency, body temperature, metabolism and endocrine activity, etc.
Second, the diagnosis of insomnia
Insomnia is a disorder in the initiation and maintenance of sleep, resulting in the quality and quantity of sleep not meeting the physiological needs of individuals, causing patients to feel that they are not fully rested and rejuvenated to varying degrees during the day, resulting in physical drowsiness, mental depression, drowsiness, reduced attention, difficulty in thinking, slow reaction, depressed mood and agitation. It is probably the most common clinical symptom other than pain, and is more common in women and the elderly.
Third, the etiology of insomnia.
It refers to chronic insomnia, which can be summarized into the following six causes.
(A) Insomnia caused by organic diseases
1, organic brain insomnia: seen in various organic lesions of the brain, accounting for about 5% of insomnia.
2.Somatological organic sleep disorder
Insomnia caused by various somatic diseases other than the brain, accounting for about 15%.
(B) Neurotic insomnia and psychophysiological insomnia
Neurosis is based on a specific personality, due to various mental factors, is the most common cause of insomnia, can account for 45-85% of insomnia. Among them, neurasthenia, anxiety neurosis and depressive neurosis, almost all of them have a complaint of insomnia.
Psychophysiological insomnia, also called primary insomnia, refers to insomnia caused by mental factors such as excessive thinking, excitement or anxiety. It is statistically believed that this type of insomnia accounts for about 30% of all insomnia. However, psychophysiological insomnia can also produce neurasthenia and symptoms of anxiety and depression. Therefore, as far as the diagnosis of insomnia is concerned, it is difficult to distinguish between the two; and there is no principle difference in the treatment of insomnia.
(iii) Insomnia caused by psychiatric diseases
Mania, depression, and schizophrenia also often have insomnia.
(D) Insomnia caused by dysregulation of wake/sleep rhythm
Exogenous insomnia is mainly seen in shift workers and those who work at night for a long time. Endogenous insomnia is mainly seen in patients with dementia.
(E) Drug-induced insomnia (omitted)
(F) Senile insomnia
The main manifestations are early sleep, shallow sleep, lack of deep sleep, more awakening sleep fragments, and early awakening is particularly prominent. In addition, sleep breathing disorders and periodic leg movements increase in the elderly, and sleep is further disturbed. Geriatric insomnia is actually a normal physiological phenomenon of the overall aging of somatic functions, and is a manifestation of the decline of brain function.
Fourth, the treatment of insomnia
With the advent of the ever-changing knowledge economy, the competition for survival and development has become increasingly fierce, coupled with the intense pace of life, high-tech knowledge and a large amount of information load on the brain’s ability to withstand the impact, neurotic insomnia and psychophysiological insomnia more and more, making insomnia a civilized disease.
The treatment of insomnia must not rely on sleeping and sedative drugs alone, but needs a set of prevention and treatment measures that are both individually targeted and universally significant according to the different symptom expressions, causes and course of insomnia; it needs doctors and patients to work together and collaborate closely, combining medical measures, psychological treatment and teaching of sleep hygiene to fight against the disease together.
V. Our experience
We treat insomnia, mainly neurological insomnia and psychophysiological insomnia, by identifying evidence and time periods.
1. We understand the patient’s medical history, symptoms, signs, and living condition comprehensively through detailed four examinations of looking, smelling, and feeling.
2. To understand the patient’s psychological disorder through specific self-assessment and other psychological tests.
3. Conduct other examinations as necessary to understand the physical condition associated with it.
4. During the daytime, the patient’s physiological and psychological conditions are comprehensively adjusted through evidence-based treatment, and sedative and hypnotic herbs or a combination of Chinese and Western medicines are given at night.
5. The treatment is mainly based on Chinese medicine, my hospital preparations include the relief of myocardium and heart pill, nourishing heart and opening yu tablets, date an capsule and so on, in addition to the commonly used Chinese medicine such as prolotherapy pill and dan gardenia prolotherapy pill.
6, many external treatment methods of Chinese medicine have unexpected curative effects. Such as plantar reflexology, chiropractic treatment, etc. External treatment method is rooted in the meridian theory of Chinese medicine, through the professional physician to adjust the meridian, to achieve the role of restoring the balance of yin and Yang, is worth vigorously promoting the green therapy.
Six, pay attention to sleep hygiene
1. Have a regular bedtime and wake up time.
2, reduce the time to stay in bed, unless it is sleep, especially not in bed reading or watching TV.
3.Distract attention.
4.Avoid coffee, tobacco and alcohol before sleep.
5.Rationalize the working time.
6.Cultivate hobbies and enrich life.
7, comfortable sleeping environment, appropriate temperature, good ventilation, neat bedding.
Seven, do not be overly afraid of sleeping pills
Although the Western sedative sleeping pills have certain side effects, but its therapeutic effect is still very obvious. “The lesser of two evils”, as long as the proper application, side effects are still smaller than the harmful effects of insomnia on the brain, follow the doctor’s orders, the appropriate application is necessary.