Insomnia is a common sleep disorder, and more than 1/3 of the general population may experience different forms of insomnia during their lifetime, with the annual prevalence of insomnia disorders lasting more than 1 month at 10-15%. Insomnia can occur at any age and is more prevalent in women than in men, about 1.41 times more common than in men. Insomnia has a significant negative impact on quality of life, but a significant number of patients are not properly diagnosed and treated. Various sleep disorders, including insomnia, have become a prominent problem threatening the health and quality of life of middle-aged and elderly people in China.
First, how long does a person need to sleep every day?
The average sleep time of healthy adults is 7.5 hours per day. In human life, sleep time has a tendency to gradually decrease with age, and in old age, the average daily sleep is only 5~6 hours. For each person, there is a large individual difference in sleep time, some people may be born with less sleep time, while others may need longer sleep time. Regardless of the length of sleep each day, as long as this time is relatively stable, you feel relaxed and comfortable after waking up, your mind is clear, and your daytime activity alertness level is appropriate and efficient, your sleep is normal.
The duration and quality of sleep can also fluctuate to some degree for each individual. Occasional lack of sleep or insomnia will have no adverse health effects.
Second, how is sleep staged?
Like wakefulness, sleep is also a state of brain activity. According to the characteristics of brain waves during sleep, combined with changes in eye movements and muscle tone, sleep is divided into non-rapid eye movement (NREM) and rapid eye movement (REM) periods.
The non-REM sleep period in turn consists of shallow to deep sleep stages 1 to 4. Under normal circumstances, a person first enters stage 1 NREM sleep after falling asleep, when the brain waves gradually slow down compared with those of wakefulness, and there are slow eye movements and high muscle tone; the sleep at this time is very shallow and easily awakened by noise or other disturbances in the environment. If there is no disturbance, the sleep soon enters stage 2, where the brain waves further slow down and characteristic spindle and K-complex waves appear, rapid eye movements basically stop, and muscle tone decreases. stage 3 and 4 sleep is characterized by the appearance of high amplitude slow waves in the brain waves, especially stage 4 is mainly high amplitude slow wave activity. stage 3 and 4 are deep sleep, when it is difficult to be awakened. During deep sleep, the heart rate slows down, breathing is slow and regular, blood pressure decreases, and energy stores increase. It is therefore an important component in determining the quality of sleep.
After a certain duration of deep sleep, we return to stage 2 NREM sleep, and then enter REM sleep, when the activity of brain waves is very similar to that of wakefulness, the eyes also show rapid movements, and the muscle tone drops to the lowest level of the day; heart rate and breathing are accelerated and unstable during REM sleep, and blood pressure increases. Dreaming occurs mainly during the REM period. REM sleep is important for human nervous system development, learning and memory functions, but many of these questions cannot be answered conclusively by former scientists.
The first REM sleep usually lasts from a few minutes to more than ten minutes, and then enters the second NREM sleep period. This periodic cycle of alternating NREM-REM sleep can occur four to five times throughout the night, with each lasting 60 to 90 minute stitches. In adults, NREM sleep accounts for about 75% to 80% of the total sleep time, including 15% to 20% of the deep sleep period; REM sleep accounts for about 20% to 25%.
Third, can insomnia cause or lead to somatic diseases?
Insomnia, especially chronic insomnia that lasts for a long time, is closely related to some physical diseases, including cardiovascular diseases, hypertension, neurological diseases, respiratory diseases, urological diseases, chronic pain, gastrointestinal diseases and cancer. This association is a “two-way street” in that, on the one hand, patients with chronic insomnia are at higher risk of developing these diseases than those without insomnia; on the other hand, patients with these somatic diseases are more likely to develop insomnia when they are ill. In other words, insomnia can be both a “cause” and a “consequence” of somatic diseases. In addition, some medications used to treat physical illnesses may also trigger insomnia.
The link between insomnia and psychiatric disorders is even closer and more complex. Among the common clinical psychiatric disorders, insomnia is most closely associated with depressive disorders and anxiety disorders, and this association can be manifested as follows.
(1) Insomnia as a symptom of these two disorders, when the patient should be diagnosed with depressive disorder or anxiety disorder.
(2) Insomnia that starts as “simple” insomnia and later induces a depressive or anxiety disorder, such as a study that reported that insomniacs had 40 times the risk of a new depressive disorder and 6 times the risk of a new anxiety disorder in the next year compared to people who did not have insomnia.
(3) When depressive disorders or anxiety disorders remit after effective treatment, but insomnia symptoms persist for a long time, both disorders can be seen as causative factors of chronic insomnia at this time. In addition, insomnia symptoms are also common in disorders such as substance abuse-related disorders, bipolar disorder, and schizophrenia.
In clinical practice, the “cause and effect” relationship between chronic insomnia and psychiatric disorders is not always easy to clearly identify. At this point, it is important to treat all the major symptoms.
IV. What are the specific sleep disorders that can cause insomnia?
Sleep breathing disorders, sleep movement disorders and sleep behavior disorders can all cause insomnia. Sleep breathing disorders, including obstructive sleep apnea syndrome (OSAS), can develop in people of any age, but men, older people, and overweight people are at higher risk of developing them. Sleep movement disorders include restless legs syndrome and periodic limb movement disorder, which are commonly characterized by abnormal increase in muscle tone or abnormal limb movement during sleep. Sleep behavior disorders include a group of behavioral, emotional, cognitive, dream, and undesired events of the autonomic nervous system that occur during sleep, such as sleep walking disorder, sleep terrors, and rapid eye movement sleep phase behavior disorder. These sleep disorders can take various forms of insomnia, but “non-restorative” insomnia is more typical, i.e., in the case of sufficient sleep time, but after waking up, the energy is not restored, there is fatigue, mental lucidity and other discomfort.
Patients with chronic insomnia, in the case of adequate conventional insomnia symptomatic treatment, still can not obtain a more satisfactory effect, it is necessary to conduct a detailed clinical assessment again, when possible, polysomnography (also known as sleep apnea monitoring, referred to as PSG) examination to determine whether there is the above-mentioned sleep disorders.
V. What are the commonly used sedative-hypnotic drugs?
The drugs used to treat insomnia are called sedative-hypnotics. First of all, it is important to point out that there is no so-called “special medicine” for insomnia. Since the occurrence and regulation of sleep involves many factors and substances, none of which is sufficient to cause or maintain sleep, and none of which is indispensable for sleep, it is difficult to predict the future development of a “special drug” for insomnia.
At present, there are two main types of sedative-hypnotic drugs used clinically in China: first, benzodiazepines, customarily known as “Valium” class, commonly used drugs such as midazolam, eszopiclone, alprazolam, lorazepam, clonazepam, etc.; second, non-benzodiazepines that selectively act on benzodiazepine receptors, represented by zopiclone, zolpidem Zolpidem, and Zalanoprom. Each of these drugs has its own characteristics and advantages in the treatment of insomnia, and must be used rationally under the guidance of a doctor. In addition, new hypnotic drugs are constantly being developed and marketed, for example, melatonin agonists have been used in clinical practice abroad.
The principle of using hypnotic drugs is to use them as needed, intermittently, and not to use them continuously every day for more than 4 weeks.
In general, the dependence of these drugs is relatively low, and the use of hypnotics under the guidance of a doctor, the real occurrence of dependence is relatively rare. Clinically, there are many patients with chronic insomnia who use hypnotic drugs for a long time and feel that they cannot live without them, even if they take a very small dose of the drug (such as a quarter of a tablet or even an eighth of a tablet) to fall asleep better; if they do not take the drug before going to bed, they will feel nervous and uneasy because they have less things to do that are “conducive” to sleep. On the other hand, they are also worried that they will not be able to sleep without medication, and eventually they will have to take medication, so they dare not easily try not to take medication. This is due to the excessive concern for getting a good sleep, and the unreasonable use of hypnotic drugs is different from the real physical or mental dependence.
The problem of dependence on hypnotic drugs should not be ignored and prevented on the one hand; on the other hand, there is no need to be overly nervous. It is equally detrimental to the effective treatment of insomnia to refuse to use any hypnotic drugs when necessary for this reason. To avoid dependence, the most important thing is not to increase the type and dose of medication without authorization, especially not to take higher doses of hypnotic drugs for a long time by yourself.
Sixth, comprehensive treatment of insomnia
The causes of insomnia are complex and varied. Physical diseases (especially chronic diseases), alcohol and other psychoactive substance dependence and abuse, various psychiatric diseases, and some special sleep disorders (such as sleep apnea, restless legs syndrome, etc.) can cause insomnia. The occurrence of insomnia is also related to genetics, some personality traits, and experiencing stressful life events. Insomnia can be caused by poor cognition, such as excessive attention to sleep, excessive consideration of how to get enough sleep, excessive worry about the “consequences” of insomnia, and various poor sleep hygiene habits, such as scheduling “enrichment” activities at night, exercising a lot, drinking a lot of coffee during the day to refresh oneself, and drinking a lot of coffee during the day to refresh oneself. Daytime drinking a lot of coffee to refresh, prolong bedtime, etc., are not conducive to getting a good sleep. Many people can fall asleep faster after drinking alcohol, but the hypnotic effect will decline after 2 to 3 days in a row; if you keep increasing the amount of alcohol you drink in order to keep the hypnotic effect, you may eventually become alcohol-dependent, and alcohol dependence itself is likely to cause insomnia, and the treatment of this substance-dependent insomnia will be more difficult.
Therefore, insomnia requires comprehensive treatment, including etiologic treatment when possible, symptomatic treatment that includes adherence to good sleep hygiene habits, psycho-behavioral therapy and the judicious use of sedative-hypnotics. The efficacy of behavioral therapy on insomnia is certain, evaluated in terms of shortening the sleep latency, reducing the time of wakefulness after falling asleep, and improving the quality of sleep, etc. Behavioral therapy can improve the sleep of 70%~80% of insomnia patients, and the efficacy is maintained for at least 6 months. Among them, stimulation control therapy, relaxation therapy and sleep restriction therapy are easy to implement and have positive effects.
Stimulation control therapy requires not doing anything other than sleeping and having sex in the bedroom and bed. If you cannot fall asleep, get up and leave the bedroom and go to another room; return to the bedroom and bed only when you feel sleepy; if you still cannot fall asleep, repeat the above steps. Also make sure that you get up regularly every day, avoid lying in bed during the day, and if you need to take a nap, then schedule one only at noon time, whether you fall asleep or not, and keep the time spent lying in bed within 20 to 30 minutes.
The common method of relaxation therapy, the specific steps are: pillow under the head soft and hard pillow; or sitting in an armchair with the back of the chair high enough to support the head. Do each action, should first make the muscle group in a state of contraction for 10 seconds, and then quickly released, in the next 20 seconds to focus on the sensation of the part, especially to experience the feeling of warmth and swelling, and then repeat twice, and then the next item. Specific action steps: fists, elbows on the floor or chair armrests; press the palms of your hands on the floor or chair armrests; press your heels on the floor; lift your heels off the floor, straighten your legs and hook your feet upward; raise your eyebrows and make a “surprise”; squint your eyes and raise the corners of your mouth; put the back of your head against the back of the chair or the floor and lift your shoulders. Press the chin to the chest; tighten the stomach and abdominal muscles. The purpose of relaxation training is to reduce the somatic tension before bedtime and the insertion of sleep-disrupting thoughts that occur during sleep time.
Seven, adhere to good sleep hygiene habits
Adhere to good sleep habits, to relieve insomnia, improve sleep treatment has a very good auxiliary therapeutic effect. For example: regular exercise, moderate amount of exercise, each duration of not less than 30 minutes, but after 16:00 should not be strenuous exercise; can make the body passive heat, such as hot bath, sauna, evening time, can have the effect of increasing deep sleep; maintain the appropriate bedroom temperature, slightly cooler may help sleep, while a warm room will improve wakefulness; control the light, in the late night to avoid strong light stimulation, night If you wake up, do not turn on bright lights, use lampshades, curtains or eye masks; control noise, in an environment where there is noise pollution but cannot be controlled, use earplugs, double windows or other items with sound insulation; control the intake of coffee and tea and avoid drinking them for at least 8 hours before going to bed; do not drink alcohol to induce sleep and quit smoking because nicotine is a stimulant that can affect sleep drink water, not too much later in the day, because frequent urination can increase wakefulness
Scientific eating, eating too much or fasting may prevent sleep, and not eating indigestible food within 2 hours before bedtime.
Eight, how should chronic insomnia patients face sleep problems
1, early consultation: insomnia should be given full attention, and should be seen by a professional sleep clinic as early as possible, so that the doctor can make a diagnosis of the nature of insomnia and develop a reasonable treatment plan.
2.If depressive disorder and anxiety disorder exist, systematic antidepressant and anxiolytic treatment must be carried out as early as possible.
3, chronic insomnia patients, do not pay too much attention to sleep, worry about the consequences, and the formation of a “vicious” cycle. Breaking the vicious circle of insomnia is a key to the treatment of chronic insomnia, so pay attention to and accept the psychological and behavioral treatment of doctors.
4, when necessary, the reasonable use of hypnotic drugs, not only do not reject, and do not have the psychology of completely “rely” on drugs to solve the problem of insomnia. It should be used reasonably under the guidance of doctors.
5.Establish confidence in the treatment of insomnia, avoid the single goal of prolonging sleep time and improving sleep quality, learn to live positively and optimistically with the “pain” of insomnia, and actively cooperate with the doctor to receive the necessary medication and behavioral treatment, your subjective satisfaction with sleep will continue to improve, and the quality of life of you and your family will be improved as a result. The quality of life for you and your family will improve as a result.