Insomnia is a fairly common disease of civilization. 36% of Americans complained of insomnia in the past year, 27% of whom suffered from transient insomnia and 9% from chronic insomnia, as evidenced by the prevalence and severity of insomnia.
I. What is insomnia?
The diagnosis of insomnia must have the following three conditions:
1. Difficulty in falling asleep or maintaining a sufficient amount of continuous sleep.
2. Inability to get rid of fatigue or regain energy from sleep.
3. At least three times a week for at least a month.
Therefore, insomnia that is generally troubled for less than a month is called transient insomnia.
Second, the causes and incidence of insomnia:
There are many causes of insomnia, so if it is not properly diagnosed, not only is the treatment ineffective, but it may also result in poor medication or drug abuse and even threaten lives. The causes of insomnia, in order of proportion, are as follows:
1, the combination of other mental illnesses accounted for 30–35% of the most, of which anxiety and depression are the most common.
2, due to some physical abnormalities of sleep: such as nocturnal myoclonus and sleep apnea syndrome accounted for 20%.
3.Primary insomnia: also known as psychosomatic insomnia accounts for 15%, and is defined as follows:
The primary insomnia is defined as the following: – excessive anxiety about falling asleep or staying asleep during the day, but not about other aspects of life, trying hard to fall asleep every night, but accompanied by an obvious fear of possible failure.
The more you try to fall asleep, the harder it is to fall asleep, but when you don’t try to fall asleep, you fall asleep easily, such as when watching TV or listening to music.
When you leave your usual sleeping room or do not sleep at the usual time, you fall asleep easily.
When you think about sleep-related matters, you feel tense and restless.
4. Drugs or alcohol cause 10-15% of insomnia: Drugs mainly contain central nervous system stimulant ingredients, such as caffeine, nicotine and amphetamines. The role of alcohol in particular, when used in low amounts, there will be euphoric effect, but up to a higher amount of sedative effect, and when sleep to the second half of the night, the blood alcohol concentration decreases, resulting in rebound phenomenon, and nightmares.
5.Sleep state misidentification disorder accounts for 5 – 10%: the patient subjectively feels insomnia, but in fact there is no objective evidence including sleep brain wave examination can be confirmed.
6.Subsequent to other physical diseases accounted for 5%: physical symptoms caused by insomnia, such as pain, breathing problems or frequent urination, some physical diseases will affect the sleep regulation center, such as dementia and delirium, etc..
7.Other reasons account for 5%.
Third, the treatment of insomnia
1.Understand the normal sleep physiology:
Normal sleep consists of four to five “cycles”, each of which contains “REM” and “non-REM”. The former is mainly a period of high brain activity, while the whole body muscle tension disappears, dreaming also occurs in this period, and it is easier to wake up. The latter can be divided into four stages: the second stage is the period of falling asleep, the second stage is the period of light sleep, and the third and fourth stages are the period of mature sleep. The sleep cycle, which is a combination of REM and non-REM periods, is about 90 – 100 minutes, and the closer to dawn, the longer the REM period, while the non-REM part of the sleep period is relatively less. Older people have lighter sleep than younger people, which is due to the reduction of the REM sleep period. Some people may complain that they have not slept all night and have been dreaming. In fact, it does not necessarily mean that they have insomnia because, as mentioned above, dreaming is part of normal sleep, which can significantly reduce muscle tension throughout the body and achieve the effect of eliminating fatigue. Therefore, if a person is woken up during the “rapid eye movement period”, he usually remembers a vivid dream, and his eyes will continue to beat rapidly and irregularly during this period, so it is called “rapid eye movement period”, which accounts for about one-fifth of all sleep time.
2. Proper sleep hygiene:
Most people who suffer from insomnia can be cured not only without medication, but also for the process of reducing sleeping pills or the treatment process for drug-dependent patients, once the following principles are strictly observed and implemented.
A. Good sleep habits:
・Bedroom and bed only for sleep, it is appropriate to turn off the lights immediately after entering the bedroom, go to bed, do not do other activities in bed such as reading books and newspapers, watching TV, etc.. If it is difficult to fall asleep in bed, get up and go to another room until sleep comes, then go back to bed. During this time, you can do some relaxation exercises, but do not engage in any stimulating or active things. Go to bed when your body is relaxed and your mood is calm (e.g., not reading or thinking about things).
・Keep the bed and its surroundings comfortable, such as the light, sound, temperature, and whether the mattress, pillow, and blanket are appropriate and comfortable.
・Try to go to bed and get up regularly, and do not change it on holidays or weekends. Even if you don’t sleep well the night before, you should get up on time every morning. A regular sleep pattern will continue to improve the quality of sleep.
Try to find out the appropriate number of hours of sleep for yourself and sleep the same length every night. If you sleep longer the day before, you will have trouble sleeping the next day. In the long run, it is better to sleep less than to be sleepy.
Do a moderate amount of exercise every day, but not at night. Studies have shown that moderate exercise moderates the sympathetic nervous system and is a good way to improve sleep disorders in the elderly.
・Try drinking a glass of sweetened milk before bedtime, which can sometimes help with sleep.
・Try to find certain activities (such as hot baths) to help establish a regular sleep cycle.
B. Avoid doing the following activities:
・Nap or catch up on sleep during the day.
Doing sports or stimulating activities at night.
・Drinking caffeinated beverages (such as coffee, tea, cola) in the evening or at night.
・Eating a dinner that is too rich or too spicy.
・Eating too late or drinking a lot of liquids at night.
・Going to bed on an empty stomach.
3. Principles of cognitive-behavioral therapy:
a. Reducing physical arousal: training in the method of gradual relaxation and physiological feedback after professional guidance.
b. Reduce anticipatory anxiety: Some people try to fall asleep because they want to control their sleep, but high anxiety can trigger autonomic arousal and make it more difficult to fall asleep. Therefore, sometimes insomniacs are asked to stay awake as much as possible to reduce sleep anxiety and fall asleep more easily.
c. Stimulus control: the main purpose in strengthening the bedroom and sleep asked the correlation, but also in the bedroom and sleep-related behavior, in order to establish a better sleep habits. Such as regular bedtime and wake up, the bed only for sleep, can not sleep should get up, until you want to sleep and then go to bed.
d. Release cognitive hyperactivity: The main purpose is to try to shift the focus of attention to non-sleep-related focus, such as
・Hyper-consciousness: Concentrate on certain special words and sounds or sutra mantras.
・Guided imagination: Imagine specific beautiful scenes or music.
4. Principles of drug treatment:
a. Try not to use drugs if you can, and first use sleep hygiene, physiological, behavioral and psychological considerations to deal with mild insomnia.
b. For the disease and cause of insomnia, it should be dealt with appropriately. If the patient has insomnia due to anxiety, depression or mental illness, appropriate anti-anxiety, anti-depressant or anti-psychotic medication should be given as the main treatment.
c. When sleeping drugs must be used, drugs with high safety and few side effects that do not affect daytime work should be chosen. After taking sleeping pills, you should completely stop engaging in other activities to avoid the possible side effects of memory loss and delayed action after taking the medication, which may cause harm.
d. Sleeping drugs should be used for a short period of time as much as possible. Although a few patients have tried to gradually reduce their medication, they are still unable to stop taking the medication. As long as their long-term medication is maintained at a low dose, it is not necessary to stop using the medication because there are no studies showing that long-term low-dose use of sleeping pills will cause any long-term or cumulative side effects on the body.
e. When using sleeping pills, patients must still receive some instruction on sleep physiology, habits, and environment, and seek to improve them in order to help them establish a good routine and moderate exercise habits. Some patients need behavioral therapy to learn to relax themselves, and some need psychotherapy to release the emotional knots.
f. If insomnia is caused by alcohol or drug addiction, it is necessary to switch to safer medications, as prescribed by a psychiatrist, and then to other therapies. After the symptoms improve, then gradually reduce the amount of medication to avoid drug withdrawal symptoms and finally reach the goal of stopping the medication.