I. Types of sleep in normal human: rapid eye movement sleep (REM) and non-rapid eye movement sleep (NREM).
1.Rapid eye movement sleep: fast wave sleep, heterophasic sleep, desynchronized sleep and G sleep.
2. Non-rapid eye movement sleep: slow wave sleep, orthophasic sleep, and synchronized sleep.
Age is the main factor affecting sleep sleep duration is negatively correlated with age; sleep latency is consistent with adults, the number of awakenings increases and waking time is prolonged; the effect on sleep cycle: fast wave sleep duration is negatively correlated with age; slow wave sleep is significantly reduced in the elderly.
The general manifestations of sleep are temporary hyperalgesia of sensory functions; hyporeflexia and hypotonia of skeletal muscles; alterations of vegetative functions: increased sweating and gastric acidity, the rest are reduced. Growth hormone secretion is increased during slow-wave sleep and decreased during fast-wave sleep and wakefulness. Protein synthesis in the brain is accelerated during fast-wave sleep.
II. Diagnosis and treatment of insomnia
Insomnia is a state of unsatisfactory quality and/or quantity of sleep that lasts for a considerable period of time.
(A) Clinical manifestations: difficulty falling asleep; difficulty maintaining sleep; early awakening.
(B) Diagnosis
1.Symptom criteria: insomnia is almost the only symptom, including difficulty in falling asleep, poor sleep, excessive dreaming, early awakening, discomfort after waking, fatigue, daytime sleepiness, etc.; with the dominant concept of insomnia and extreme concern for the outcome of insomnia.
2.Severity criteria: dissatisfaction with the quantity and quality of sleep causes significant distress or impaired social functioning.
3.Criteria of disease duration: occurring at least 3 times a week and for at least 1 month.
4.Exclusion criteria: exclude secondary insomnia caused by symptoms of somatic diseases or mental disorders.
WHO sleep quality evaluation criteria 30 minutes to fall asleep; deep sleep, deep and long breathing without snoring, not easy to wake up at night; less waking up, no night terrors, forgetting dreams soon after waking up; good spirit in the morning after waking up; clear mind during the day, high work efficiency, no sleepiness.
Diagnosis of insomnia pays special attention to long-term insomnia with anxiety, depression or obsessive-compulsive symptoms; insomnia is a very common symptom of other mental disorders: depression, neurosis, organic mental disorder, eating disorder, psychoactive substance-induced psychosis, schizophrenia, etc.; insomnia is one of many symptoms of somatic conditions; whether transient insomnia is an acute stress disorder, adaptation disorder, if the course of the disease is not enough to diagnose insomnia sub If the duration of the disease is not enough, the diagnosis of insomnia subclinical state should be made.
(C) Treatment
1, non-pharmacological treatment supportive psychotherapy; cognitive-behavioral therapy: irrational expectations, exaggerated insomnia results, change of false views, techniques such as reattribution training, de-catastrophizing, re-evaluation, attention shifting; relaxation therapy: biofeedback, meditation, hypnosis; sleep restriction (oppositional intention therapy): that is, mild sleep deprivation; stimulus control therapy: reduce non-sleep-related behavior, establish regular sleep patterns .
2.Chinese medicine treatment
(1) Traditional Chinese medicine treatment: Jiu Wei Shen An capsule, Yixing Brain capsule, Li’s Sleeping Fragrance Patch, Bai He Zao Ren capsule.
(2) Food therapy: pig heart and date soup (one pig heart, 15 grams each of date palm and poria, 5 grams of Yuan Zhi).
(3) Foot therapy: insist on foot soak, foot massage, and add sour date palm, 20 grams of Yuan Zhi, 10 grams of Acacia bark, and 5 grams of vermilion decoction for foot soak in severe insomnia.
Third, the diagnosis and treatment of narcolepsy
A state of excessive daytime sleep and prolonged transition time to reach the fully awakened state during sleep episodes or waking. Not due to sleep deprivation, drugs, alcohol, somatic diseases, some kind of mental disorder (such as depression, neurasthenia) part of the symptoms.
(a) Clinical manifestations: excessive daytime sleepiness. There are two types.
1, with long sleep type: night sleep more than 10 hours, daytime sleepiness without mental recovery (i.e. sleep Moet state).
2, not with long sleep type: night sleep less than 10 hours, daytime sleepiness without sleep Moet state.
(II) Diagnosis
1.Symptom criteria.
(1) Excessive daytime sleep or sleep attacks.
(2) No lack of sleep time.
(3) No prolonged time from awakening to full wakefulness or apnea during sleep.
(4) No additional symptoms of episodic sleeping sickness (sudden collapse, sleep paralysis, pre-sleep hallucinations, pre-wake hallucinations).
2.Severity criteria: significant pain or impact on social function.
3, the course of the disease criteria: almost daily occurrence, at least has been January exclusion criteria Not due to sleep deprivation, drugs, alcohol, physical illness, some kind of mental disorder symptom components.
4.Differential diagnosis of episodic sleeping sickness
(1) one or more additional symptoms.
(2) irresistible sleep episodes and mental invigoration upon awakening.
(3) daytime episodes lasting for a short time and cannot be restrained.
(4) Sleep disorder at night, easy to wake up dreamy, fragmentary, transient III. Diagnosis and treatment of narcolepsy.
5.Differential diagnosis of obstructive sleep apnea hypoventilation syndrome
(1) Nocturnal apnea with typical intermittent sounding.
(2) Obesity, hypertension, cardiac arrhythmia, heart attack, stroke.
(3) Cognitive deficits, memory loss.
(4) Nocturnal hyperactivity, hyperhidrosis, polyuria, proteinuria.
(5) Morning headache, daytime drowsiness.
(6) Impotence.
(C) Treatment
1.Non-pharmacological treatment with planned daytime naps
2.Medication
(1) Modafinil: 400mg , new central stimulant, headache.
(2) Sodium oxybutyrate: 500mg/ml, 9g, central depressant, nausea, enuresis, sleepwalking.
(3) Methylphenidate (Ritalin): 100mg, central stimulant, tachycardia, hypertension, anorexia, hyperactivity.
(4) Dextroamphetamine.
IV. Diagnosis and treatment of non-organic sleep-wake
Dissynchrony between the human sleep-wake rhythm and the sleep-wake rhythm allowed by the environment, resulting in patients complaining of insomnia or drowsiness.
(I) Etiology
1. Human biological clock: hypothalamic supraoptic nucleus.
2. Main synchronization factors: light, physiological activity, melatonin.
(B) Clinical manifestations
1.Delayed sleep phase: difficulty falling asleep during the traditional sleep time period, difficulty waking up in the morning, preventing the execution of daytime functions. Fall asleep at 2-6 am and wake up at 10 am-1 pm. Prevalent in adolescents, with a 7% incidence
2. Sleep phase advance: a sleep disorder in which the main sleep time is fixed in advance. Fall asleep at 6-9pm and wake up at 2-5am. It is common in middle-aged and elderly people, with an incidence of 1%.
3. non-24-hour sleep-wake syndrome: periodic insomnia, drowsiness, or both, alternating in the form of short non-synchronous cycles. It is more common in blind people.
4, shift work system type disorder: difficulty falling asleep, difficulty maintaining sleep, lack of post-sleep freshness, drowsiness at work. 5-10%.
5, jet lag syndrome: endogenous sleep-wake rhythm is temporarily inconsistent with the time cycle of the environment caused. Difficulty in falling asleep, difficulty in maintenance, daytime sleepiness, and reduced operational ability.
(C) Diagnostic symptom criteria
1. the patient’s sleep-wake rhythm is not consistent with the required (i.e. with the social requirements of the patient’s environment and the rhythm followed by most people)
2. the patient has insomnia during the main sleep period and drowsiness during the time when he/she should be awake.
3. severity criteria: apparent distress or impaired social functioning duration criteria: occurring almost daily and for at least one month.
4. Exclusion criteria: exclude secondary sleep-wake rhythm disorders caused by somatic diseases or psychiatric disorders (such as depression).
(D) Treatment
1. General treatment: maintain the normal drive to sleep, reduce the alertness of the person, reduce the effect of drugs, and reduce the awakening during sleep.
2.Special treatment
(1) Treatment of sleep phase delay.
(1) Synchronization therapy: the method of gradually delaying the time of sleep and wakefulness by 3 hours every 1-2 days until a normal resting time is maintained.
(ii) Intense light therapy: 1-2 hours of light exposure at 2000-2500lux given at 6-8 am.
(③) Melatonin: 0.3-3mg at night, effective for 4 weeks.
(2) Treatment of sleep phase advance.
(i) Intense light therapy: 4 hours of light given from 8 p.m.
(2) Synchronization therapy: 3 hours of sleep advance every 2 days.
(3) Treatment of non-24-hour sleep-wake syndrome: 10 mg of melatonin 1 hour before bedtime and 0.5 mg at 9 pm.
(4) Treatment of shift work type disorder Strong light therapy: 5000-10000lux light is given at the beginning of the night shift and ends 2 hours before the shift; black goggles to block the morning light; melatonin 1-3 before bedtime; wake-promoting agents: caffeine, modafinil.
(5) Treatment of jet lag syndrome: eastward flyers have the least light intensity in the morning and the greatest in the afternoon, westward flyers keep awake when there is light outside; melatonin 2-5 mg before bedtime for 4 nights; zolpidem 10 mg for 3 nights .
V. Diagnosis and treatment of sleep walking disorder
An altered state of consciousness in which sleep and wakefulness coexist, with waking and walking, low levels of attention, reactivity and motor skills in the first third of the night. It cannot be recalled afterwards.
Common in childhood, coexisting with febrile illness; precipitating factors: psychotropic drugs, alcohol, pregnancy, psychotic episodes; causative factors: stress, fever, hyperthyroidism, encephalitis, genetics, etc.
(A) Clinical manifestations
Within 2-3 hours of initial sleep; simple daily habitual movements; partly complex behavior; purposeless behavior; impulsive, aggressive, escape behavior after being restricted; lasting for several minutes to ten minutes; difficult to wake up and completely forgotten afterwards.
(II) Diagnostic symptom criteria
1. Recurrent episodes of getting up and walking in sleep. Dazed expression, dull gaze, lack of response, and difficulty in waking up during seizures; automatically return to bed or lie down to sleep after seizures; may have transient consciousness and disorientation at the beginning of awakening after seizures, but return to normal after a few minutes, and complete amnesia both in immediate awakening and the next morning.
2. Severity criteria: not significantly affecting daily life and social functions.
3.Course of illness criteria: repeated episodes of sleep waking and walking for several minutes to half an hour.
4.Exclusion criteria.
(1) Exclude organic diseases such as dementia, epilepsy, but can coexist with epilepsy.
(2) Exclude hysteria.
5. Differential diagnosis of psychomotor epilepsy.
(1) Rarely seizures only at night.
(2) complete unresponsiveness to environmental stimuli.
(3) EEG changes.
(iii) Treatment
1. General treatment: prevention of injuries, management of objects in the home; do not try to wake him up; symptoms disappear after 10 years of age.
2. Behavioral treatment: hypnotherapy, early awakening.
3.Medication: diazepam, clonazepam, phenytoin sodium, promethazine, chlorpromethazine.
6. Diagnosis and treatment of sleep terrors
Are episodes of extreme fear and panic that appear at night, accompanied by intense speech, motor forms and high autonomic excitement. Seizures occur in the first third of sleep; often rushes to the door but rarely leaves the room; will lose orientation for a few minutes; cannot recall after waking.
(I) Clinical manifestations
Most often seen in children aged 3-7 years; once a month to several months; extreme fear and panic attacks; lasts 1-10 minutes before falling back to sleep; no recollection afterwards.
(II) Diagnosis
1. recurrent episodes of awakening from sleep after a panic scream, inability to maintain appropriate contact with the environment, accompanied by intense anxiety, somatic movements, and autonomic hyperactivity, lasting 1-10 minutes, with episodes in the first third of sleep.
2. relative lack of response to the intervention of others, with disorientation and sustained movements for several minutes if interfered with.
3. amnesia afterwards, with very limited recall if any.
4. Exclude organic diseases and febrile convulsions.
5. Differential diagnosis of nightmares.
(1) Occurs at any moment of sleep.
(2) Easily awakened and recalled in detail.
(3) Generally no speech and somatic movement.
(3) Treatment: the same as the treatment of sleep walking disorder.