Every Monday at the sleep specialist clinic, there are always patients who ask me: “Doctor, am I suffering from intractable insomnia”? Let’s first search on Baidu, what is persistent insomnia? Persistent insomnia is often caused by psychological factors, the main clinical manifestations are difficulty in falling asleep and maintaining sleep, daytime fatigue, the more you want to fall asleep at night, the more difficult it is to fall asleep, aggravating psychological conflict, resulting in tension and anxiety, emotional instability, excessive worry, self-consciousness pain leads to insomnia, forming a vicious circle. This can be said to be the classic definition of intractable insomnia, so is intractable insomnia really very intractable in clinical practice? In fact, true intractable insomnia is very rare. The kind of highly exaggerated cases of prolonged sleeplessness that seriously affect the health of the body are very rare clinically. There was a woman named Li Zhanying in Henan Province, once widely reported by TV, who did not sleep for forty years and got up in the middle of the night to do farm work. It was later scientifically confirmed that she only had a change in the form of sleep, while people generally sleep at night, she did not distinguish between time and occasion, and this sporadic sleep added up to even more than a good sleeper. First, we need to understand that sleep is controlled by the vegetative nervous system in the body. When a person is tired, the vegetative nervous system automatically regulates itself to fall asleep. The higher nerve centers can sometimes force themselves not to go to sleep, but this coercive effect does not last long, just as a person cannot control his heartbeat and sweating. In the war years, a soldier can reach sleep while marching, or during artillery bombardment. Insomnia patients often have the experience of “wanting to fall asleep but having difficulty falling asleep”, which in fact is to use their own higher nerve center to fight against their own vegetative nerves, which actually plays a counterproductive role in preventing themselves from sleeping. Second, we need to understand what anticipatory anxiety is. We call it anticipatory anxiety when we are nervous, worried, distressed, and even frightened about something that is not happening. For example, before an exam, most people are a little nervous that they will not do well, so much so that they will drink water, go to the bathroom, etc. Proper anxiety is actually somewhat good for this, allowing people to maintain a good state of quick thinking. Once it happens, that anxiety goes away. In a sleep disorder, this anticipatory anxiety is of little benefit. Many sufferers of insomnia really suffer not in bed, but before they go to sleep. Whenever night falls, these people begin to think, “What if I can’t sleep tonight?” “Should I take my medication?” “How much to take?” This excessive worry and anxiety only reinforces the fact that one is an insomniac. That’s why there is a saying in the trade, “Anxiety is the killer of sleep.” Of course, there are some insomnia patients who may be caused by “anxiety”, which is a different story. Again, we need to understand the role of medication as an aid to sleep. The first drugs used to treat insomnia were barbiturates, which are effective but so addictive that they are no longer used to treat insomnia. Benzodiazepines (Valium, such as alprazolam, eszopiclone, clonazepam, etc.) are widely used because they are more effective and less addictive. However, due to the emphasis on quality of life, the side effects of benzodiazepines such as drowsiness and hangover (feeling weak when you get up the next day, as if you just woke up from a drunken night) are still difficult for many insomnia patients to accept. There are already non-benzodiazepines such as zopiclone, dexrazopiclone, zaleplon, etc. Although there are also various side effects on the instructions, the side effects are almost negligible in the case of regular doses for insomnia. I often tell my patients that this medication is like a gas stove in the house, it only serves to ignite the fire, and what it conjures up is your real sleep. Finally, based on the above points, I have a few suggestions for insomnia patients. First, understand sleep correctly. Sleep is not something that can be interfered with artificially, and sometimes it is counterproductive to think too much about it. Usually some sleep experts or textbooks introduce the need to pay attention to sleep hygiene, and that is for people who sleep well. If you already have a sleep disorder and you do this, you may be overly concerned, which will only reinforce your “bad sleep”. The Buddha said “let it be”, which is a good state of mind. Second, believe in doctors, believe in medicine, “faith is the spirit”. Although our ideal is “baby sleep”, medicated sleep is not as terrible as you think, if you already have a sleep disorder, you may want to accept this type of medicated sleep, only when you really accept it, you can get rid of sleep troubles. One day, you may be able to sleep without drugs. We do not advocate that the patient to the drug instructions word for word, can prescribe drugs to the doctor is to go through many years of professional learning, not a manual to see the disease, will use drugs. Third, face life positively and dissolve all psychological factors. The world will become beautiful with your kindness, equality, clarity and tolerance. If you do the above points, you then ask, are you a persistent insomniac? Of course, there are many diseases and causes of sleep disorders, and insomnia is only a secondary symptom, which I will talk about in future pages, so I won’t go into it here.