l Insomnia is one of the common symptoms of sleep disorders.
lSleep disorder is a common disease with complex clinical manifestations. Sleep disorders are closely related to a variety of diseases, and sleep disorders may co-exist in patients of various clinical disciplines, and various diseases themselves may also be complicated by sleep disorders. With the continuous advancement of modernization, the increasingly fierce competition in society, and the accelerated pace of people’s work and life, the incidence of sleep disorders has been increasing. 2002.3.21~25 “Global Sleep Survey” sponsored by the International Foundation for Mental Health and Neuroscience (IFMHN) showed that in China, 45.4% of people have sleep disorders. 45.4% of people have sleep problems (28% of them have insomnia and 17.4% have suspected insomnia).
Sleep disorders seriously affect people’s life, work and physical and mental health, as well as the resulting sick leave, accidental injuries, accidents, reduced work efficiency and productivity, etc., bringing negative impact on families and society. Therefore, sleep disorders are both a medical and social problem.
Normal sleep and its role
l Most healthy people spend one third of their lives in sleep, and sleep is closely related to everyone’s life, and poor sleep will seriously affect people’s physical and mental health.
lGood sleep helps people’s body, including muscles and brain, to rest and recover, and plays an important role in people’s immunity and children’s growth and development.
Normal sleep time
lUsually, it is customary to think that adults should have 8 hours of sleep a day, but the actual individual differences are quite large, some people may sleep enough for 4 to 5 hours to meet the physiological needs, about 10% of the healthy population belongs to this situation; 15% of people sleep more than 8 hours, or even more. The average sleep time of the whole population, about 7.5 hours, is the origin of 8 hours of sleep.
In human life, the sleep time required varies with age. 10 months old infants need at least 16 hours of sleep per day, 2~3 years old toddlers need at least 12 hours of sleep, elementary school children should have 10 hours of sleep, teenagers need about 8 hours or more, and as for adults, 6~8 hours are usually enough. After entering old age, sleep time gradually decreases, but there are some people who always stay the same or increase instead, which is a common individual difference.
It is generally accepted that adults and older adults should consider the presence of disease if they sleep more than 10 hours or less than 4 hours. However, for adults, the amount of sleep needed varies from person to person, with some people needing 5-6 hours, some needing 7-8 hours, and some may have to sleep more than 9 hours to relieve fatigue. Of course, there are a few healthy people sleep 3 hours a night is enough, is not rare. It is said that Edison only two hours of sleep a day to recover, and buried in new inventions; and Napoleon often only need to lean on a tree to doze, immediately eliminate fatigue. Premier Zhou Enlai, at most, can only sleep 4 to 5 hours a day, and refreshed to deal with state affairs.
Some people don’t sleep long, but they wake up refreshed and feel comfortable and satisfied; others sleep for a short time, but they either dream a lot or wake up easily, and they feel sleepy after sleeping all night. Therefore, clinically, when judging how well a person sleeps, both sleep time and sleep quality should be considered.
Judgment of sleep quality standard
l1. Fast sleep (within 30 minutes)
l2. Deep sleep, not easy to wake up
L3. Less waking up, no awakening, forgetting dreams after waking up
L4. Wake up quickly, good spirit
L5. clear mind and high efficiency during the day
What is insomnia?
Insomnia is a subjective experience of unsatisfactory sleep time and/or quality, including difficulty in falling asleep, sleep maintenance, or waking up early and not being able to fall asleep again. Common complaints are waking fatigue, reduced daytime alertness, listlessness, and impairment in cognitive function, behavioral performance, or emotional state, along with reduced quality of life.
lDSM-III-R (1985).
Insomnia is defined as complaints of difficulty falling asleep or maintaining sleep for at least 4 nights per week for at least 3 consecutive weeks. Polysomnography reveals a sleep latency of more than 30 minutes and/or a sleep efficiency of less than 85% (with appropriate adjustments in the elderly)
Classification of insomnia (according to the course of the disease)
l Transient or acute insomnia: duration <4 weeks;
l Short-term or subacute insomnia: duration >4 weeks, <3-6 months
l Long-term insomnia or chronic insomnia: duration of illness > 3 to 6 months.
Classification of insomnia (according to the severity)
l Mild insomnia: Occasional insomnia with little impact on the quality of life;
l Moderate insomnia: occurs every night, moderately affects the quality of life, accompanied by certain symptoms (irritability, anxiety, fatigue, etc.);
l Severe insomnia: occurs every night, moderately affects the quality of life, with prominent clinical symptoms (irritability, anxiety, fatigue, etc.).
Causes of insomnia
l1. Environmental factors: noisy and noisy environment, too bright lights, too high or too low bedroom temperature, too high humidity, uncomfortable beds, too crowded, etc. Mobility of work often on the go to spend the day, or travel environment, etc.
l2, cognitive psychological factors: anxiety and tension, sadness and boredom, excitement and anger, excessive thinking, etc. There is a fear of sleep, fear of nightmares, fear of sleep onset, fear of not waking up once asleep, etc. These fears can cause or aggravate insomnia.
l3, acquired insomnia (habitual insomnia): is due to the formation of a conditioned reflex insomnia behavior to.
l4, physiological factors: such as hunger, overfullness, unresolved sexual arousal, etc., lying in bed and killing time too long also tend to cause insomnia.
l5, sleep-wake program disorder: jet lag reaction, night shift.
l6.Subsequent to state of mind (mental) disorders: such as anxiety, depression, schizophrenia and certain personality disorders, etc.
l7. Secondary to somatic conditions: common ones such as pain, itching, cough, bloating, polyuria, asthma, etc. hyperthyroidism, sleep apnea syndrome, nocturnal myasthenic syndrome, restless legs syndrome, etc.
l8, substance or drug use or withdrawal: tea, coffee, Coca-Cola, central nervous system stimulants; and alcohol withdrawal, sleeping pill withdrawal.
l9. Combined factors: life events or persistent competitive work environment or incongruous family life environmental factors with cognitive and mental fine tuning disorders, which affect the normal regulation of the sleep system, may be a common combined cause of chronic insomnia in modern society.
Treatment of insomnia: an overview
The treatment of insomnia usually begins with the elimination of the cause of insomnia, which can have multiple causes;
lThe treatment of insomnia includes a combination of pharmacological and non-pharmacological means.
Treatment of insomnia.
Treatment of insomnia: I. Sleep hygiene
Treatment of insomnia: II. Psychotherapy
l Relaxation therapy.
lMusic therapy
lSupportive therapy
lCognitive-behavioral therapy
lSleep restriction therapy
lStimulus control therapy
Treatment of insomnia: III. Medication
lSleeping drugs may be considered for obvious insomnia.
lFirst-line drugs: non-benzodiazepine selective GABA-A receptor agonists.
l benzodiazepines
lSome new antidepressants.
lLong-term use of sleeping pills is advocated if withdrawal would affect the patient’s quality of life or if other treatments are ineffective.
Treatment of insomnia: IV. Exercise therapy
lIn order to live and survive, people must rely on the activities of the brain and limbs to meet all their physiological needs, and then rest and sleep to continue the next stage of activity. This is a physiological cycle that is inevitable.
l If you want to get a good night’s sleep, it is essential to develop exercise habits.
l Treatment of insomnia: V. Diet therapy
l Modern medical research proves that tryptophan in food protein can cause temporary inhibition of brain thinking activity, making people feel sleepy. Suitable foods to eat before going to bed are millet, milk, potatoes, noodles or vegetables with a little chicken or fish. These foods can prompt the brain to secrete a hormone called serotonin, which has a relaxing, calming effect; cheese, yogurt is rich in calcium, which can promote the role of serotonin; magnesium-rich bananas, oatmeal and eggplant, tomatoes, celery also help sleep.
Treatment of insomnia: VI. Biofeedback technology
l Through modern electronic instruments, the electrophysiological changes in the patient’s body are traced down and simultaneously converted into intuitive feedback signals such as sound, light or screen images. Patients learn to adjust their physiological functions according to the feedback signals that keep appearing, so that the physiological functions can be restored to or maintained at a suitable level, thus achieving the purpose of prevention and treatment.
l Each session is 10-15 times for 30 minutes each. Initially 2 to 3 times a week, and then gradually extended to once a week or once every half month.
Treatment of insomnia: VII. Light therapy
l Mainly used for patients with sleep rhythm disorder sleep disorder.
Treatment of insomnia: VIII. Others
l1.Compound vitamin B12
l2.Flower aroma sleeping aerosol
l3.Some protein/peptide bioengineering products
l4.Nutritional natural sleep aids
l5, sugar compounded sleeping aids
l6.Compounded amino acid sleep aids