Treatment of insomnia: Non-pharmacological treatment (slow onset, need to persist): Establish good sleep hygiene, correct behaviors that affect sleep
Regular working hours, going to bed on time and getting up on time whether or not you still feel like sleeping.
Soundproof, shaded, moderate temperature, comfortable and safe sleep environment.
Do not go to bed full or hungry.
No strenuous exercise, no quarrels and excitement before going to bed.
Do not read or watch TV in bed.
Daily moderate regular exercise (can be arranged in the afternoon, not in the 2 hours before bedtime).
Do not drink alcohol (4 hours before bedtime), coffee or tea (6 hours before bedtime), and do not smoke after dinner.
Try to avoid daytime naps.
Psychotherapy.
Cognitive therapy: establish correct cognition
Do not take 8 hours as the standard of normal sleep, as long as the next day’s energy is normal (false perception: I must sleep 8 hours, otherwise my body will collapse).
Not being overly concerned about the negative consequences of insomnia, leading to fear of insomnia (misperception: if I have a little bad sleep, I will not have energy to do anything during the day).
Behavioral therapy.
Gradual muscle relaxation training, biofeedback to help learn to relax.
Go to bed only when you feel like sleeping, don’t watch the clock too often; if you can’t sleep, leave the bedroom and go back to bed when you feel like sleeping. So that the bedroom and bed do not become a conditioned stimulus for insomnia, but rather a conditioned stimulus for good sleep.
Patients who wake up early may try to get up earlier and not remain in bed.
Medication.
First, the cause of insomnia should be identified and treated for the cause. Second, understand the specific situation of insomnia: difficulty in falling asleep; easy to wake up during sleep, dreamy; early awakening ;
Choice of hypnotic drugs.
Difficulty in falling asleep: short-acting drugs
Difficulty in maintaining sleep, early awakening: medium-acting drugs, or long-acting drugs (for those with severe daytime anxiety)
Commonly used hypnotic drugs.
Benzodiazepines (Valium): non-selective GABA receptor agonists
Strong sedative-hypnotic and anxiolytic effects.
Inhibits breathing, affects cognition, muscle relaxation, and affects ataxia.
Long-term application can produce dependence, sudden discontinuation has withdrawal symptoms, the starting dose should be small.
The shorter the half-life, the faster the onset of action, the shorter the duration of action, the easier to produce dependence; the longer the half-life, the slower the onset of action, the longer the duration of action, the less likely to produce dependence, but affect the cognitive function during the day.
It can be used intermittently in small doses to avoid dependence and addiction.
Long-acting drugs: clonazepam, diazepam, nitrazepam, etc;
Medium-acting drugs: alprazolam, estradiolam, lorazepam, etc;
Short-acting drugs: triazolam, midazolam, etc.
Non-benzodiazepine selective GABA receptor agonists:
Fast onset, does not affect the normal sleep physiology; short half-life, small residual effects, no residual discomfort during the day the next day: sleepiness, fatigue, cognitive impairment, ataxia, etc.; little rebound phenomenon; no anxiolytic effect. Commonly used are: zolpidem, zopiclone, zaleplon
Antidepressants.
NaSSAs class (mirtazapine)
Trazodone: selective inhibition of 5-hydroxytryptamine reuptake, may also accelerate the renewal of dopamine in the brain.
SSRIs class: early often aggravate insomnia symptoms, consider combining benzodiazepines (except fluvoxamine and paroxetine which have sedative effects).
Small doses of second-generation antipsychotics: quetiapine, olanzapine, etc.
Principles of hypnotic drug use.
Select drugs after clarifying the cause of insomnia; start with small doses and individualize the dose; gradually reduce the dose and discontinue drugs with dependence after they are effective; drugs with dependence should be given intermittently as needed; past medication history helps to correctly select drugs; be alert to aggravate depressive symptoms; pay attention to respiratory depression, liver and kidney function.