Sleep and insomnia Dong-Yuan Huang Sleep disturbance is an extremely common health problem and the most common complaint heard among patients in hospital outpatient or inpatient settings. Insomnia is a symptom common to more than one psychiatric disorder, with patients with anxiety and depression being obvious examples. According to surveys, nearly 30% of the population has experienced insomnia, with up to 17% of the population suffering from insomnia of sufficient severity to require the use of medication; the percentage is even higher in the elderly insomnia population over the age of 65, five or six times that of the younger population. These problems do not include daytime sleepiness and other problems that occur with abnormal sleep behavior.
In the past, people believed that the main function of sleep is to eliminate fatigue and let the body rest, but in fact, eliminating fatigue is not the primary purpose of sleep.
The human brain is an extremely sophisticated and complex structure, occasional, short-term sleep deprivation, although it will immediately react to the daytime mental and emotional, but generally for the brain and body functions, but not so much impact, as long as after a little rest, can be quickly recovered; long periods of sleep deprivation is a serious consequence, not only affect the daytime life functions, the body and mind can have a negative impact, but also It may also have a negative impact on existing diseases.
In children, the secretion of growth hormone is blocked, which affects the growth and development of the body; in adults, sympathetic nerve function is hyperactive, and the metabolism increases at night and during the day, which affects the recovery of functions, weakens the immunity of the body, and aggravates various existing physical and mental disorders. It affects work and study efficiency, especially mental activities related to memory, calculation and logical reasoning. Emotional frustration and agitation, which in turn affects interpersonal relationships and the quality of personal life. Sleep deprivation greatly increases the occurrence of accidents. According to statistics, car accidents caused by insomnia in the United States account for 7% of the overall accident rate; the number of deaths amounts to 24,000 per year. It is estimated that in 1988, the cost of traffic accidents in the United States due to insomnia alone amounted to about $43 billion to $56 billion. The cost of insomnia can be divided into direct and indirect costs, as with other conditions. Direct costs include: medical expenses, doctor visits, tests for diagnosis, hospitalization, medication, and other interventions. The National Council on Sleep Disorders Research (NCS-DR) reported that $15.4 billion was spent on insomnia patients in 1990 and $13.9 billion in 1995. These costs include prescription drugs, as well as over-the-counter drugs such as alcohol and melatonin. Indirect costs are more difficult to assess, and include factors such as the impact on the patient’s health, financial loss, reduced work productivity, absenteeism, receipt of substances or services, dependence on family members for help, and death, etc. Indirect costs for insomnia patients may be higher than direct costs, all of which illustrate the seriousness of the problem of insomnia, the impact of which is so great that it is feared to exceed that of other disorders.
I. The concept and diagnosis of insomnia
Insomnia is a disorder of sleep onset (sleeponset) and sleep maintenance (sleepmaintenance). It is a subjective experience that the quality or quantity of sleep does not meet the normal requirements. Insomnia has become a very common phenomenon in today’s fast-paced society and increased competition.
Insomnia can be divided into “sleep insomnia”, “sleep maintenance insomnia” and “early awakening insomnia”. In fact, in general, insomnia patients have mixed insomnia, often with two or three of the above-mentioned manifestations at the same time. At present, there are three international criteria for the diagnosis of insomnia, namely the International Classification of Sleep Disorders (ICSD), the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and the ICD-10 classification of mental and behavioral disorders. These diagnostic systems overlap and have some differences in the diagnosis of insomnia and its subtypes.
The common features are: (1) difficulty in falling asleep, easy waking, difficulty in falling back to sleep after waking, excessive dreaming, early waking, etc.; (2) impaired social functioning and distress, lack of wakefulness in the morning, low energy, daytime fatigue or sleepiness, poor concentration, reduced ability to work or study due to impaired cognitive function, concern about insomnia and worry about the consequences of insomnia and resulting distress; (3) exclusion of various psychoneurological and somatic disorders. ④The duration of insomnia lasts for more than one month. The purpose of specifying the duration of insomnia is to distinguish insomnia from occasional insomnia or short-lived insomnia (less than 1 month) in order to avoid drug abuse or unnecessary burden on the patient. In addition the most important International Classification of Sleep Disorders (ICSD) makes the diagnosis of acute, subacute and chronic insomnia, which is important for the choice of treatment.
Second, the incidence of insomnia
Insomnia is a common disorder, and its degree varies from transient and occasional insomnia to chronic and severe insomnia, and the incidence of insomnia varies from report to report. It depends on the definition of insomnia, the time of assessment, and the method of data collection. Epidemiological studies have shown that one third of adults in the United States have sleep disorders, 21% in Japan, 17.8% in Canada, 11.9% in Finland, and 19% in France. 20% to 36% of insomnia patients have been ill for more than one year, and a survey by Cheralier et al. in five Nordic countries found that the duration of severe insomnia was 2 to 5?8 years. Another survey of 2512 people aged 16-64 years in primary care found that 66% met the DSM-3-R diagnostic criteria for insomnia lasting more than one year, and 52% had moderate to severe insomnia after two years of follow-up. Some populations are particularly vulnerable to insomnia, such as depression, chronic pain syndrome, and the elderly. More than 50% of people over the age of 65 have sleep problems. According to the National Institute on Aging survey of 9,000 older adults over the age of 65, 28% had difficulty falling asleep and/or waking up too early, 29% had trouble maintaining sleep, 18% complained of early awakenings, and only 12% had no sleep problems. A 2003 US population survey on sleep found a linear relationship between sleep problems and many physical illnesses, with older adults with four or more medical conditions having a higher rate of insomnia than those with only one condition, and 20% of those with four or more medical conditions sleeping less than six hours, compared to 10% of those without medical conditions. The reduced amount of slow-wave sleep is associated with normal aging.
III. Assessment of insomnia
Insomnia is the most common symptom of physical and psychological disorders that scandium is unimaginable to people with sleep disturbances. However, perhaps because insomnia is so common, it is less relevant to the pathology and diagnosis of physical and mental illness than other disorders. However, this record often requires several consecutive days or even weeks of understanding to get a true picture.
Insomnia includes phenomena such as difficulty falling asleep, premature wakefulness, or sleep that is easily interrupted or not easily sustained, and each of these has its own specific pathological significance.
Indicators for evaluating the effectiveness of insomnia treatment
The indicators currently used for the evaluation of insomnia treatment include time to fall asleep, duration of sleep maintenance, total sleep time (TST), sleep efficiency, sleep continuity, sleep quality, and sleep cycle, but none of these parameters takes into account the functional state during the day. Sleep onset and maintenance play an important role in the diagnosis of insomnia, but without a reduction in TST, the assessment of treatment is of limited value.Sleep efficiency is an important determinant of sleep hygiene, but is not related to the functional state during the day.Sleep continuity and TST can be important indicators for the assessment of insomnia treatment.Impaired TST affects alertness, operational function, memory, increases the risk of traffic accidents The risk of traffic accidents, decreased pain threshold and insulin resistance. Impairment of sleep continuity also affects alertness, functional function, memory, and reduces growth hormone and prolactin release.
There are few parameters to assess the effectiveness of insomnia treatment that reflect the improvement of insomnia-related problems. The treatment of insomnia should not only relieve symptoms, but also prevent the occurrence of insomnia-related diseases, which should be reflected in the assessment of the effectiveness.
Assessment of residual daytime symptoms
One extremely important and common manifestation of sleep disorders that is often overlooked by patients and providers alike is the assessment of the patient’s daytime residual symptoms. Physical symptoms such as weakness, muscle pain, etc., are often associated with irritability and unhappiness, which often leads to reduced motivation for occupational, social and functional life. These daytime residual states must be carefully differentiated from the original physical and mental illnesses to avoid misdiagnosis.
Generally, symptoms due to insomnia improve rapidly after a good night’s sleep; however, sleep and wakefulness are a continuum, so the assessment of insomnia must be done in a holistic manner over a period of at least twenty-four hours.
The assessment of daytime sleepiness is another important development in clinical sleep medicine. In fact, daytime hypersomnia has a greater impact on life functioning and is a greater threat to life and property than nocturnal insomnia. Moreover, daytime sleepiness is more often associated with an underlying specific sleep disorder or organic cause than nighttime insomnia, and early medical attention is needed to avoid worsening the condition. While daytime and nocturnal sleep problems may each have a unique pathology, the relationship between the two needs to be clarified in the clinical evaluation.
We often find that insomnia patients take inappropriate methods during the day, such as less daytime activities, or even try to supplement sleep during the day; this situation will instead disrupt the daytime biological clock, which in turn affects the next day’s sleep and becomes one of the main factors in the chronicity of insomnia, which is not good for long-term sleep prevention and health care.
Four, sleep laboratory tests
EEG, which not only records the patient’s brain wave changes during nighttime sleep, but also includes the simultaneous recording of heart rate, respiration, blood oxygen concentration, and physical activity, sometimes including the peristalsis of the digestive tract and the acidity of the esophagus, or the sexual function measurement of the erection of the penis or clitoris at night, etc. However, exactly how many tests need to be included must also be determined by the clinical situation.
The main function of such sleep laboratory tests is to exclude specific sleep disorders and to engage in pathological analysis, K providing specific data as objective clinical indicators. Most physicians with specialized psychiatric training are able to make a correct diagnosis. At present, sleep tests are more needed to be applied to confirm the diagnosis of certain specific sleep disorders such as respiratory and central nervous system. In particular, sleep apnea has been the focus of clinical sleep medicine in the last two decades.
Obstructive sleep apnea is the most common organic sleep disorder in clinical practice, and laboratory tests can help to calculate the number of respiratory arrests and hypopneas per hour as an indicator of clinical severity. In addition, laboratory measurements can also measure the patient’s oxygen saturation and the number of arrhythmias per hour, which are important reference values for specific respiratory or cardiovascular diseases.
Multiple sleep electroencephalography is not yet widespread in China, and only a few large educational hospitals currently offer this service, not only because of the cost and human skills. Therefore, a more conservative approach is still generally taken in the treatment of sleep apnea tentative disorder, such as weight control and correction of diet and substance abuse habits.
V. Treatment of insomnia.
(A) The use of sleeping pills
The use of sleeping pills has always been the most troubling problem for doctors and patients.
The rapid effectiveness and high safety of current pharmacological treatments have indeed made sleeping pills the primary treatment for physicians over the past two decades, and a source of psychological conflict for patients. Although it is true that many insomnia patients require the phased use of sleeping pills as a treatment, in the same sense that diabetic patients must use hypoglycemic drugs and hypertensive patients use blood pressure-lowering drugs, society at large is still full of many uncertainties and confusions about sleeping pills, one of the most common problems being the fear of addiction or dependence. In fact, the sleeping pills that are currently widely prescribed and applied have a sexual K unlike other adult a drugs, and physical dependence is not difficult to deal with, it is precisely the psychological dependence and excessive fear that to instead becomes the greatest psychological burden for the patient.
The treatment of insomnia, like assessment, must be comprehensive, with medication playing only a part, and other modalities such as specialized cognitive-behavioral therapy, psychosocial problem management, and psychotherapy being required. Given the current medical environment in China, the gap is indeed wide. Therefore, medication alone is unable to meet the intense needs of insomnia patients. Therefore, the public’s distrust of sleeping pills is actually a result of the underdeveloped sleep medicine; but at the same time, @N social resistance to the psychological anti s prevents the use of mace E.
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Insomnia type, accompanying symptoms, drug half-life, adverse drug reactions and other comprehensive consideration of the advantages and disadvantages of drug use, choose the lowest effective dose.
1, benzodiazepines (benzodiazepines, BZD)
Benzodiazepines are still the most widely used hypnotic drugs. With safe, fast-acting, well-tolerated and other characteristics. The pharmacological effects of this class of drugs include anti-agonism, sedation, anxiety reduction, muscle relaxation and anti-epilepsy.
It is mainly through enhancing the central GABAergic synaptic transmission, thus strengthening the inhibitory effect of GABA on the center. This class of drugs has a wide range of effects and is mainly used in psychiatric clinics to improve sleep and reduce anxiety.
The main antiepileptic agents are diazepam (especially for grand mal seizures) and chlordiazepoxide (for petit mal seizures and non-grand mal seizures). Drugs with long half-lives are generally not suitable for the elderly to avoid accumulation and hangover.
All benzodiazepine agents have addictive and alcohol-like effects, and dependence is seen mainly with long-acting drugs. Because of the many potential problems associated with the use of traditional benzodiazepines, such as drug addiction, dependence, and hangover, and because they prolong total sleep time while impairing the two most important components of sleep: slow-wave sleep (SWS) and rapid eye movement sleep (REMS), they do not really improve sleep quality. Since the 1980s, the use of novel, structurally unrelated benzodiazepine receptor agonists, including zopiclone, zolpidem, and zaleplon, has received increasing attention in clinical practice. Estrogen replacement therapy can improve the subjective and objective sleep of patients with menopausal syndrome.
(1) Drug selection: Different types of BZD are selected according to the type of insomnia, and BZD is divided into three categories: long-acting (>24hr), medium-acting (6~24hr) and short-acting (<6hr) according to the length of half-life (t1/2).
Short-acting BZDs are triazolam, which is a daily dose of 0,25~0,5 mg to help sleep, and should be taken orally before sleep, starting with 0,125 mg and gradually increasing the dose if necessary; this drug is currently classified as a controlled class I because of the potential for abuse or memory impairment. Psychotropic drugs should be used with caution in patients with depressive symptoms; medium-acting BZD include lorazepam, estazolam and alprazolam, with daily doses of 1-2 mg, 1-2 mg, 0, 4-0, 8 mg, taken orally at bedtime, and should also be used from small doses and increased as appropriate.
For those who have difficulty in maintaining sleep or waking up early, it is advisable to use medium-acting or long-acting BZD. see above for types and usage of medium-acting BZD; long-acting BZD include clonazepam, flurazepam, daily dose is 2~4mg, 15~30mg, taken orally before sleep.
(2) Abuse and dependence: At present, BZD abuse has become more common in the clinic (including psychiatric and non-psychiatric), which is manifested in: (1) the use of BZD without analysis of the cause of insomnia; (2) for insomnia in mental disorders, other drugs with strong sedative effects have been used, plus BZD, most often clozapine (or chlorpromazine) + BZD; (3) once the use of BZD, do not envisage the timely withdrawal .
There have been reports of BZD addiction since the 1960s, related to the length of use, and the relationship with dose is not certain. Dependence includes both psychological and physical, with the latter showing withdrawal symptoms. In order to avoid the formation of dependence, clinical indications should be strictly controlled and inappropriate long-term application should be avoided.
There is also a more common concern among patients and family members, who are overly afraid of addiction to the drug and therefore often do not follow medical advice for treatment, which needs to be explained by doctors. BZD is safer and less addictive than older sleeping pills.
(3) Withdrawal symptoms and prevention: Generally appear 5-7 days after interrupting the drug, withdrawal symptoms last 1-7 days, symptoms manifest: nervousness, emotional instability, irritability, fear, tremor, sweating, insomnia, sensory allergy, loss of appetite, nausea, headache, eye pain, dizziness, depersonalization, palpitations, etc. In severe cases, spasms, disorders of consciousness and psychotic symptoms appear.
The following drugs can be used for the treatment of withdrawal symptoms: ① propranolol (insulin): 10mg, three times a day; ② colestipol: 0,075mg/dose (or halved), 2~3 times a day, pay attention to monitoring blood pressure; ③ buspirone: 5m/subg, 3 times a day; ④ carbamazepine: 0,1g/dose, 3 times a day for those who have spasmodic seizures.
To prevent the occurrence of withdrawal symptoms, the following points should be noted: ① Avoid abuse, especially long-term application; ② Gradual discontinuation: there is no definite reduction method, some recommend starting with a half dose, and then reducing the dose by 10%-20% every 3-5 days, in 4-8 weeks. Some people emphasize that those who apply short-acting BZD can switch to long-acting BZD if they want to withdraw, and then gradually stop; ③ If withdrawal symptoms are found, the application of BZD can be temporarily resumed, and appropriate treatment measures can be taken, as mentioned above.
(4) Attention to problems during application.
① For longer-term users, it is best to frequently switch BZD types to prevent drug resistance.
(2) For short-acting BZD users, sudden discontinuation should be noted for rebound phenomena (including insomnia and anxiety), i.e., insomnia and anxiety that are more intense than with the drug.
③ Avoid stopping the use of BZD abruptly, you can take the decreasing method, or change the short-acting BZD to long-acting BZD first.
④Side effects of BZD are rare, but sometimes excessive sedation, weakness, headache, blurred vision, vertigo, nausea, vomiting, epigastric discomfort, abdominal pain, diarrhea, arthralgia, ataxia, and nystagmus can occur. Paradoxical behavioral reactions may also occur, including aggressive behavior, hostile attitudes, criminal behavior such as theft, sexual assault, increased speech, anxiety, emotional instability, uncontrollable crying and laughing, euphoria, hallucinations, light manic states, irritability, delusions, depression, suicidal ideation, weight gain, rash, sexual dysfunction, and menstrual disorders. These paradoxical reactions are most common in the first 1-2 weeks after drug initiation or during dose increments and usually resolve on their own.
⑤ Respiratory depression may occur with BZD in people with respiratory disease, especially when administered intravenously (diazepam is commonly used to treat grand mal seizures, and slow intravenous injection is advisable, while closely observing respiratory status; intramuscular injection is poorly absorbed).
(6) Long-term application may cause memory impairment.
(7) The elderly may fall at night due to sudden muscle relaxation during the application of BZD, or become unconscious, which needs to be closely prevented.
⑧In the beginning of BZD application, you should be advised not to engage in car or bicycle driving.
⑨Females should avoid application during pregnancy, especially at the beginning of the third trimester; if breastfeeding is needed, this drug should be discontinued.
2. zolpidem (zolpidem) chemical name is zolpidem tartrate, trade name Sinox, Lotan, is a non-benzodiazepine sedative, short duration of action, the average half-life of 2, 5 hours. In small doses, it shortens the time of falling asleep and prolongs the duration of sleep; in larger doses, the duration of phase II sleep, slow wave sleep (phase III and IV sleep) and rapid eye movement period (REM) sleep latency time are prolonged and REM sleep time is shortened.
It is indicated for symptoms such as difficulty in falling asleep, easy to wake up, and excessive dreaming. It should be taken before sleep and started in small doses, the dose of sleep aid is 5~20mg/d. The dose should be reduced appropriately and observed when used by elderly people or patients with physical diseases; it should not be taken by children under 15 years old, pregnant women and nursing mothers.
Side effects can be sleepiness, dizziness, headache, nausea, diarrhea and vertigo.
3, zopiclone (zopiclone) trade name yimengzhi, Simengzhi, Aubeshuxin. Belongs to the cyclopyrrolidone class of drugs, non-benzodiazepine sedative, can enhance sleep time, improve sleep quality, reduce the number of night awakenings, and avoid early awakening. It has a half-life of about 5 hours.
It is suitable for all kinds of insomnia, taken before sleep, commonly used dose 7,5mg/d; elderly and hepatic insufficiency reduce by half.
Side effects occasionally seen daytime drowsiness, bitter mouth, dry mouth, muscle weakness, headache, fatigue, irritability, etc.
4, antidepressants Balter et al. reported: between 1970 and 1990, the number of people using prescription sleeping pills fell from 3.5% to 2.5%. The National Disease and Treatment Index shows that between 1987 and 1996, the use of sleeping pills fell by about 20%. There was also a change in the variety of drugs used for sleep, with a significant decline in prescription sleeping pills and a rapid increase in low-dose antidepressants used as adjuncts for insomnia. The use of antidepressants is safer for the treatment of chronic insomnia, and the use of antidepressants increased by 146% from 1987 to 1996, while the use of sleeping pills decreased by 53.7% in 2006 during the same period. Trazodone is by far the most frequently used antidepressant, and although the total amount of trazodone use remains the same, the number of prescriptions for antidepressant purposes has decreased while the number of prescriptions for sleep has increased substantially. It has become the most frequently prescribed drug, even surpassing the number of zolpidem. Tricyclic antidepressants (e.g., clomipramine, amitriptyline, doxepin, etc.) have a sedative effect and can be used to treat insomnia secondary to depression. However, these drugs have poor safety profile, long T1/2, and are prone to anticholinergic side effects.
Patients with chronic insomnia often have mood disorders, and insomnia itself is one of the important symptoms of depression. Therefore, patients with chronic insomnia can use antidepressants at their own discretion, usually using antidepressants with sedative effects, such as paroxetine 10~75 mg/d, mianserin 60~200 mg/d, maprotiline 150 mg/d, amitriptyline 100~100 mg/d, and amitriptyline 100~100 mg/d. amitriptyline 100~300mg/d or doxepine 100~300mg/d orally before bedtime.
(B) Diagnosis and management of insomnia in special patients
1.Chronic pain and insomnia
Insomnia with chronic pain, which is non-restorative sleep, is common in patients with chronic skeletal muscle pain, fibromyalgia or chronic fatigue syndrome (CFS). The main manifestations are shallow sleep, lack of freshness upon awakening, physical and mental fatigue, variable and nonspecific pain, overreaction to noxious stimuli, irritability, and autonomic dysfunction. Sleep EEG characteristically shows alpha rhythm EEG activity in slow wave sleep. Treatment: includes cognitive-behavioral therapy, sleep hygiene, and appropriate aerobic exercise. The non-benzodiazepine drugs zopiclone, zolpidem and growth hormone, 5hydroxy-L-tryptophan can improve sleep quality, but they are not effective for EEG abnormalities such as alpha activity in slow-wave sleep. The effect on EEG abnormalities is not clear.
2.The elderly and insomnia
The consequences of insomnia in the elderly include increased likelihood of traffic accidents or falls, decreased quality of life, and other symptoms such as inability to concentrate, slow reaction time, memory impairment, and decreased work capacity. Because the elderly often have a variety of medical conditions, they need to be treated with a variety of drugs, and drugs can increase the risk of insomnia. The 2003 U.S. public opinion survey on sleep found that 20% of the elderly use drugs to help them sleep, including prescription drugs, over-the-counter drugs, alcohol, of which 15% take drugs every night or basically every night. Non-pharmacological treatment, sleep hygiene education, behavioral therapy, etc.
3.Depression and insomnia
Sleep disturbance is a common symptom of depression, and the most characteristic one is early awakening (EMA), which is part of the diagnostic criteria of major depression. Clinical manifestations are insomnia and hypersomnia, or alternating episodes, with relatively high incidence of bipolar depression and seasonal depression with excessive sleepiness. The decrease in the amount of sleep in patients with bipolar disorder can be an indicator of a shift to mixed episodes, psychotic or manic episodes, and depression and anxiety co-morbidity can increase the likelihood of worsening sleep.
Tricyclic drugs, due to their high number of side effects and potentially lethal effects in overdose, have been largely replaced by selective 5-HT reuptake inhibitors (SSRIs) worldwide. subjective sleep improves during SSRI treatment, a phenomenon that may be related to an underestimation of the number of short awakenings, partly due to the alleviation of negative cognitive appraisals accompanying depression, but a minority of patients with no improvement in sleep or even worsening when using an SSRI. There is evidence that monotherapy with trazodone, nefazodone, and mirtazapine (at moderate doses) can alleviate insomnia with depressive disorders, and trazodone is currently used less frequently as an antidepressant. Mirtazapine is a tricyclic-like compound, a powerful blocker of 5HT2, 5HT3 and histamine receptors, which has the strongest onset of sedation inhibiting REM sleep, significantly reducing nocturnal arousal and wakefulness, and preserving sleep architecture and daytime alertness, but needs to be confirmed in large sample studies.
(iii) Over-the-counter drugs for sleep are convenient and have a wide range of options, the most commonly used being antihistamines. These drugs have a weak sedative and tranquilizing effect, with anticholinergic and antihistamine effects. Melatonin is an indole hormone secreted by the pineal gland and has hypnotic, sedative, and sleep-wake cycle regulating effects. It is mainly used for the treatment of sleep rhythm disorders caused by physiological rhythm disorders, including delayed sleep phase syndrome, jet lag reaction, sleep disorders caused by shift work, etc. It is more effective for elderly patients with insomnia. The efficacy of this drug is uncertain, and it has a theoretical tendency to aggravate depression at doses above the physiological level, suppressing the secretion of endogenous melatonin. In addition, supplements with “natural” ingredients such as valerian (root), catnip, chamomile (chamomile), cola tree, passion flower, etc. are commonly used in the treatment of insomnia. But so far, there is no information to confirm the role of these “natural” substances, the key to have a controlled study, the U.S. FDA has not yet made clear provisions.
(D) Chinese medicine treatment of insomnia, known as “sleeplessness” in Chinese medicine, is thought to be caused by emotional and moral injury, lack of rest and relaxation, long-standing illness, physical weakness, over-extension of the five wills, poor diet and other factors that cause a loss of yin and yang, and yang does not enter the yin, resulting in this disease. The clinical symptoms are mild or severe, with the milder ones only having trouble sleeping and the more severe ones staying awake all night. Chinese medicine classifies insomnia into 7 types, and different types are treated with different prescriptions.
(E) Non-pharmacological treatment of insomnia
1, psychotherapy (1) general psychotherapy: through explanation, guidance, so that patients understand the basic knowledge about sleep, reduce unnecessary anticipatory anxiety reactions; (2) behavior therapy: relaxation training, teach patients to do before going to sleep, accelerate the speed of sleep, reduce anxiety.
2, biofeedback can enhance self-relaxation training, which is effective for reducing anxiety.
3, physical exercise appropriate physical exercise to enhance physical fitness, aggravate the sense of somatic fatigue, for sleep is appropriate. However, it is not easy to exercise too much, excessive fatigue but affect sleep.
4, adjust the habits of life, such as the cancellation or reduction of naps, and develop the habit of timely sleep.
Six, insomnia preventive health care
How to face insomnia insomnia is not terrible, afraid to have a psychological burden optimistic attitude to life, many things in the world can not be forced. But sometimes it is easier said than done.
1, sleep is the same as eating, not everyone has the same amount of meals, and likewise everyone’s sleep time is different, as long as you do not have a serious sense of sleep deprivation, then even if you only sleep 5 hours a day, is also normal, no need to worry about sleep deprivation.
2, a few nights in a row poor sleep also do not need to worry, can listen to its natural, fatigue always sleep well.
3, anyone’s sleep is not the same every day, not necessarily the same good sleep every night.
4, if possible, it is best to sleep as much as every day, a day to sleep 5, 6 hours may not feel fatigue, sleep every day for a different time, is a longer sleep, there is still fatigue.
Pay attention to several problems before going to bed
1, do not drink strong tea, coffee and other excitatory drinks after eating dinner.
2, keep the bedroom environment quiet, dim, the temperature is appropriate. Beds and bedding clean and comfortable.
3, drinking alcohol has a temporary hypnotic effect, but can make people sleep unsubstantial, wake up early, so it is not advisable to drink before bed.
4, the bed is used to sleep, do not watch TV in bed, read a book, and do not think about the problem in bed, some things should be thought about before going to bed or simply leave it for tomorrow.
5, a sense of fatigue after sex, and relaxation, conducive to sleep.
6, do not eat too much before going to bed, because after eating too much gastrointestinal movement will strengthen, is what Chinese medicine said “stomach and restlessness”
Self-relaxation training
Lie down on the bed, close your eyes and breathe naturally. Then focus your attention on your hands or feet, relax your whole body muscles extremely, and use the feeling of heaviness to experience the degree of muscle relaxation. Meditate on self-referential statements: “My feet are getting heavier”, “My lower limbs are getting heavier” …… “My whole body is getting heavier”. As soon as you realize the intention that has nothing to do with the feeling of heaviness of the limbs, you should immediately stop and focus your attention on the experience of the feeling of heaviness of the hands and feet, patients can generally relax and fall asleep during the exercise. Adhere to a period of training this method, there are good results.
Music therapy
Before going to bed, to a soft, monotonous music may have some effect. Hearing good music, like a child sitting in the cool of a summer night listening to an old grandmother telling beautiful mythological stories, or like the beach in the sun, called a person’s heart and soul, temporarily forget about worries, relaxed mood, so as to sleep peacefully therapy two: acupuncture for insomnia, the acupuncture points include: Nei Guan, Shen Men, An Mian, Foot San Li, Hou Xi.
Treatment 3: Ear acupuncture
The practitioner will apply Wang Bu Liu Xing seeds to the heart, kidney, Shen Men, subcortical or brain acupuncture points in the ear, according to the symptoms of the insomniac. For those whose insomnia is not serious, they can use mung bean or fenugreek seeds at home on their own, and apply them with adhesive tape to the sleeping points behind the ears to help restful sleep.
Treatment 4: Food therapy
Insomnia can be cured by dietary therapy in medicinal food, generally without any side effects, is a natural therapy, without any side effects, insomniacs may wish to try.
Ginseng soup ingredients: 20 grams of princely ginseng, 30 grams of schisandra.
Directions: Decoct and add syrup, take 15 ml each time, twice a day.
Efficacy: cure insomnia, panic and weakness raw lily soup ingredients: raw lily 100 grams practice: raw lily with 500 ml of water, decoction with moderate heat and add appropriate amount of sugar, divided into two or three times to take.
Efficacy: for the residual heat after the disease has not been cleared, heart yin deficiency of false annoyance and insomnia.
Sour date porridge 30 grams of sour date, 10 grams of cypress kernel, 1 tael of round-grained rice, cooked together into a porridge;? Lily and lotus seeds soup 30 grams each of lily and lotus seeds, first boil the lotus seeds, to be crisp, add lily and boil, add sugar to eat;? Gui Yuan Lotus Seed Soup 20 grams of lotus seeds, soaked, add water, cooked over moderate heat, then add 10 cinnamon, cooked together.
Lotus seeds red dates porridge 30 grams of lotus seeds, red dates 30, wash, add water and boil, add 2 taels of round-grained rice, cook porridge;? Red dates and cinnamon soup 20 red dates, 10 cinnamon, add water and boil soup.
Sour date kernel: sweet and flat in nature, enters the heart and liver meridian, used for palpitations, insomnia, spontaneous sweating.
Phellodendron: sweet and flat in nature, belongs to the heart, kidney and large intestine meridian, its effect is to nourish the heart and calm the mind, laxative and laxative, used for sleeplessness, palpitations and palpitations, constipation and intestinal dryness.
Lily: Sweet, slightly cold. It belongs to the heart and lung meridians. Moistening the lung and relieving cough, clearing the heart and calming the mind.
Cinnamon: Sweet, warm. Belongs to the heart and lung meridians. Tonifying the heart and spleen, benefiting the vital energy and blood. Used for palpitations and insomnia, shriveled face, less energy and weakness.
Lotus seeds: Sweet, astringent and flat. It has the effect of nourishing the spleen and benefiting the kidney, tonifying the kidney and fixing the essence, nourishing the heart and calming the mind.
Red date: sweet, warm. Has the effect of strengthening the spleen and stomach, nourishing blood and calming the mind.