As a psychiatrist, it is not uncommon to treat insomnia with medication. Over the years of practicing medicine, many patients have indeed regained a good night’s sleep and never had to take medication again. But in the face of some poorly treated patients, or patients who came to me with clonazepam, olanzapine, mirtazapine, I had to think again, if we had been gentler with our medication, and the patient’s psychological problems had been solved earlier, would the current treatment have been better? Insomnia may seem like a simple problem, but it often hides a deep psychological problem behind it. The more certain psychological treatment now is cognitive-behavioral therapy. There are many schools of psychotherapy, and each school’s approach does not explain or solve all psychological problems, so it is not really practical to use a single psychotherapy tool for clinical application. This is the reason why psychotherapy is being integrated today. In clinical practice, the application of psychological foundations to solve simple psychological problems such as insomnia can often achieve better results, and even simple counseling can bring back the patient’s dreams. Understanding the true cause of insomnia and letting go of inner baggage. Life events are not to be underestimated in psychiatry, and often some mental illnesses have a strong relationship with life events. And the term psychological conflict is often used in psychology, which seems more accurate when applied to insomnia patients. Many patients emphasize that I am not experiencing anything on the one hand, but on the other hand there are obvious psychological factors that they cannot let go. For example, a woman whose husband had an affair and raised a son outside the home has reconciled, but her insomnia remains. In the context of traditional Chinese culture, which woman can allow her husband to have a child with another person within the marriage and let go of it herself? There is also an old woman, daughter and son both marriage failure and divorce, to this insomnia to seek treatment, although to the doctor repeatedly stressed, “I do not care about them, now divorce is very much, I just want to put myself to sleep well.” I can’t help but ask, have you really put down the baggage in your heart? As a doctor, you can’t actually solve a patient’s psychological conflict with actual action, but some psychological conflicts may be much weaker once they are stripped of their pretense and exposed. For example, a retired teacher, who lent his years of savings of 50,000 yuan to a long-time friend out of the goodness of his heart, developed insomnia because the other party could not afford to return it. Frequent visits to the doctor, but there is the nobility of treating money like dirt and ashamed to start the shame of the matter, after being asked by the doctor, a week later there was a significant improvement in sleep. Self-deprecatingly said, “50,000 yuan and does not affect their lives, but spend tens of thousands of dollars to see a doctor, it seems that I still take money too seriously.” Understand the natural process of sleep and reduce disturbances to sleep. The importance of sleep can be recognized by everyone. The kind of person who can die suddenly after 29 hours of continuous Internet surfing is not unknown, but simply because of the obsession and frenzy of online games that make it impossible to stop, right? However, people who overemphasize the importance of sleep tend to sleep for the sake of sleep. Once the bedtime is exceeded or the amount of sleep is not enough think of the adverse consequences that result. “The more I try to sleep, the more I can’t sleep” is a common voice among many insomnia sufferers. The truth is that sleep is a physiological process that is not directed by the human brain, just like sweating and beating. When we “want to sleep”, in fact, our brain is already interfering with sleep. “The more we can’t sleep, the more we want to sleep” makes this interference more and more intense, plus the patient’s previous experience of insomnia makes people become anxious, and finally becomes “do not go to bed to want to sleep, get into bed to wake up.” So how do you reduce the brain’s interference with sleep? In general, if you can relax, shift your attention, and let nature take its course, sleep may come unannounced. Relaxation is the opposite of tension, and tension is a problem that many insomniacs are not aware of. After a day’s work, people are in a state of physical and mental tension, and this is a time when they especially need to relax through sleep, and once they have insomnia, not only do they not get relaxed, but they aggravate this tension. Therefore, for people with insomnia, an active relaxation process is very necessary. Relaxation is also one of the most common means of psychotherapy, and insomniacs can learn a method of relaxation under the guidance of a psychotherapist. I will introduce an imaginary relaxation training method to you. Patients can imagine themselves lying on the grassland, the whole person is very comfortable, very far away there are white flocks of sheep, the sky is very, very blue, only a few white clouds are floating, there is a kind of breeze that can not feel around themselves blowing around. Then concentrate your mind on your head, and every hair starts to fall naturally; the whole tight scalp loosens piece by piece, with no weight at all. (Think of every part of yourself and imagine them losing gravity). The whole process is usually 10-15 minutes, preferably accompanied by soothing breathing. To repeat the above process according to your situation, possibly. Understand the nature of the medication to rule out pharmacogenic insomnia. Insomnia patients are more worried about drugs than normal people, not only because of the drugs themselves, but also from the consensus of those around them, including most doctors. There are several processes in the development of sedative-hypnotic drugs, and the first drugs with a definite effect are barbiturates and aldehydes, which are undeniably tolerable and addictive for long-term use, so they are hardly used to treat insomnia clinically. With the advent of tranquilizers, tolerance and addiction have been greatly reduced, especially alprazolam, eszopiclone, clonazepam, lorazepam, oxazepam and other tranquilizers have also overcome the weaknesses of common valium (diazepam), and the proportion of patients who develop addiction is very low, so they can be widely used. In recent years, a large number of non-benzodiazepine (non-Valium) drugs have been developed, and some of the side effects inherent in Valium itself, such as inotropic, heart rate slowing, and respiratory depression, have been greatly reduced. However, most people’s awareness of sedative-hypnotics is still at an earlier time, so that the fear of the drugs continues unabated. This is not unrelated to the propaganda of our doctors. In clinical practice, in addition to using sedative-hypnotics to treat insomnia, sometimes we may also use certain antidepressants and antipsychotics possessing sedative and drowsy side effects to treat some patients with severe insomnia. Because of the stronger effect of these drugs and the ability to see immediate results, they are now very popular with some doctors. In my opinion, it is better to use them sparingly unless the patient himself possesses psychiatric symptoms or emotional abnormalities. I am afraid that some of the proprietary Chinese medicines often seen in the clinic nowadays are difficult to use as first-line drugs because of their weak effects. I am afraid that some doctors and patients deliberately pursue this type of medication because of a misunderstanding of the aforementioned drugs or other factors. Understanding the patient’s coping mechanisms and reshaping good character The above is very simple, but difficult to do. This is the reason why many patients fail to achieve good outcomes, I believe. Therefore, using these supportive psychotherapies alone is not enough. As a doctor, it is necessary to use psychological knowledge to help patients identify their own coping mechanisms for psychological conflicts, so that they can discover the deficiencies of such mechanisms themselves and stimulate their own energy in an effort to recreate a good character. If the patient or the doctor decides to use psychotherapy to change something underlying the patient, I am afraid that both parties will have to be prepared for a long battle. Of course, if the patient is suffering from other physical or psychiatric disorders that are causing the sleep disorder, it is best to have a clear diagnosis and to address the primary cause with pharmacological or non-pharmacological means. However, the above methods will also be helpful for insomnia symptoms. Finally, a saying comes to mind, “Take your time with the mind.”