The most common symptoms in our neurology clinic: dizziness, headache, and insomnia. Insomnia is often accompanied by dreams and nightmares. There are several cases among my patient friends.
A. Female, 41 years old, company employee. Due to her husband’s work problems mood has been relatively low, daily irritability, two months ago no obvious cause of paroxysmal ? irritating dry cough, appeared bilateral limb weakness, numbness of the extremities, only able to walk about 100 meters; accompanied by nocturnal sleep disorder, easy to wake up early after sleep, symptoms every night 1-2 o’clock episodes obviously, can no longer sleep; accompanied by night sweats, hunger, nausea, dizziness, headache, for the occipital pulsating pain; all day long for the disease, depressed, fidgety, after the disease to what She is not interested in anything, does not watch TV, does not go to work; feels that her hands are hot, her legs (below iliac) are weak, she coughs when she smells stir-fry, does not care about family affairs, and does not want to see people when they come; her throat is dry, her bowels are dry; she feels more tired lying at home than doing a day’s work.
B. Female, in her 40s, daughter studying in France. There was a riot in France at one time, and the child did not come. I couldn’t reach her by phone or email. She was worried about her child’s situation, so she went around every day to inquire, and was so anxious that she couldn’t sleep through the night.
C. Female, in her 50s, because her son is getting a divorce, but she thinks her daughter-in-law is very good and does not agree with her son’s divorce, but she cannot control him. Appeared anxious, depressed, always felt sad with mice running on her back; also developed anorexia nervosa, vomiting, and the most painful thing was insomnia. Can’t stay away from sleeping pills, taking up to 18 sleeping pills at a time.
The above three women’s insomnia condition are all “insomnia with anxiety and depression ”. The reason is: the position they are in, the things they have to do, more than their ability. For example, A want their husbands’ work to be smooth; B want to get news of their daughters immediately; C want to keep their sons from getting divorced; strong pressure makes them lose their own reality and lose their personality when playing social roles; guilt about their loved ones makes them often in self-blame. The state of the family, the competition in society, the emergence of unexpected events make people lonely, sad and depressed to the point of insomnia. Insomnia is a permanent topic. From ancient to modern people, from heads of state and leaders to common people, all suffer from insomnia. A large proportion of the population suffers from insomnia. Foreign epidemiological survey results show that about 33% of people in the world have sleep disorders every year; 17% of people have serious insomnia; the incidence rate is about 20% in developed countries and about 10% in developing countries. Domestic surveys in China show that the prevalence of insomnia is about 8.6%.
By and large, insomnia is more likely to occur in groups with higher levels of education and higher social status in the brain workforce.
In 68% of insomnia patients, the onset of insomnia is accompanied by emotional triggers; more than 1/2 of the 32% of insomnia patients who deny having emotional triggers also share the characteristics of insomnia patients with emotional disorders, such as difficulty in falling asleep, shallow sleep, restless sleep, difficulty in waking up, and inability to fall back asleep after waking up; frequent or prolonged waking periods? Daytime fatigue and weakness affect normal life.
Insomnia can be caused by psychological reasons or by physical illness. Lack of sleep can make a person unable to concentrate, have difficulty in learning, reduced attention to details of things, increased risk of car accidents……. The diseases that have an impact on sleep conditions are, in order: pain 32%, hypertension 24%, prostate and other diseases (causing increased nocturia) 18%, coronary heart disease 16.7%, snoring 16.7%, cerebral atherosclerosis 13%, skin diseases 9.9%, ulcer disease 7.4%, diabetes 4.9%, hyperthyroidism 2.5%, and obesity causes.
Insomnia has the symptoms: 1, difficulty falling asleep, or sleep after not feeling relieved & mdash; & mdash; on the surface, sleep time enough, but people feel not really rested; the above symptoms at least 3 times a week, the period of illness lasts at least a month. 2, the severity of the degree when the person feels significantly tired during the day, or others can be observed to have symptoms caused by insomnia disorder. 3, does not show in the & ldquo;Sleep-wake duration disorder” (insomnia caused by jet lag belongs to sleep—wake duration disorder), or the course of sleep disorder.
Although insomnia is not an independent disease, but as a symptom, it is the result of psychological factors, social factors, other diseases, the balance of the human plant nervous system function, interference. Therefore, the treatment of insomnia, if only the intervention with sedative insomnia drugs, not involving the possession of 62% of the psychological triggers, will only increase the abuse of drugs and insomnia symptoms persist. Sleep disorders belong to “the most typical phenomenon of autonomic stimulation of the animal system” and are a way of manifesting dysfunction of the autonomic nervous system after external disturbances. Others are gastrointestinal dysfunction, cardiac dysfunction, menstrual disorders, etc., but in general, the response of sleep to external stimuli comes more quickly. Often, the cause of chronic insomnia lasting more than 3-4 weeks may be closely related to psychological factors, and this insomnia may be caused by an affective disorder.
There are many causes of insomnia, such as: change of environment, sleeping place, noisy sound, uncomfortable light, poor ventilation
poor, bedpan too hard, pillow too high or too low, flight jet lag, etc.; diet: smoking, alcohol, tea, coffee, sweets; drug use: such as monoamine oxidase inhibitors (anti-phenylcycline, phenylhydrazine, boring cola, etc.), some weight loss drugs, some antidepressants, thyroid drugs, some diuretics and epinephrine-mimetic drugs, etc.; the relationship between sex and age: more women than men, more elderly people over 65 years old .
The natural awakening and nocturnal waking time in human sleep increased from 5% of sleep time at age 20 to more than 20% at age 85. This may be related to the abnormal secretion of melatonin associated with sleep as we age.
Insomnia caused by somatic diseases—— circulatory system: hypertension, coronary heart disease, cardiac insufficiency, angina pectoris often occurs during sleep, postural dyspnea in heart failure makes patients unable to lie down and difficult to sleep; endocrine system: hyperthyroid patients often wake up during sleep, fear, anxiety, rapid pulse, sweating, low A patients who take Diabetic patients can have the same symptoms due to changes in dietary intake, increased urination, and accompanying peripheral nerve damage leading to sleep problems; respiratory system: asthma, lung infections, and obstructive emphysema, all of which can cause awakening due to difficulty in breathing exchange; central nervous system: cerebrovascular disease, brain tumors, Parkinson’s disease, dementia, etc.; digestive system: pain due to ulcer disease, intestinal discomfort caused by parasitic diseases; dermatological diseases: allergic diseases, itchy skin; painful aspects: rheumatoid arthritis, muscle pain, advanced tumors; urinary system: urinary tract infections, frequent urination due to prostate enlargement, accumulation of harmful objects in the body due to uremia.
Insomnia caused by psychological factors. The cause of about 50% of insomnia may be psychogenic. Chronic insomnia
Approximately l/3 to 2/3 of patients with insomnia have psychiatric disorders of varying degrees, with depression being the most common. Insomnia is present in approximately 95% of patients with endogenous depression; other psychiatric problems such as anxiety states, obsessive-compulsive thoughts, post-traumatic stress disorders, anorexia nervosa and dementia may also underlie chronic insomnia.
Insomnia can lead to brain hypoxia, triggering rapid memory loss, cerebral infarction, and Alzheimer’s disease. Sleep per
The onset of complications in diabetic patients with less than 4 hours of sleep per day is 6 years earlier than the same patients with more than 6 hours of sleep; late sleep for women is equal to smoking a joint, women with frequent insomnia will prematurely aging, early menopause; men engaged in brain work insomnia, in a highly stressed state is likely to trigger sudden death by overwork; insomnia in students can cause neurasthenia and memory loss. Normal sleep, defined as “ promote the body to recover from fatigue and have an appropriate period of time ”. It is divided into two main periods: non-rapid eye movement sleep (also known as slow-wave sleep) and rapid eye movement sleep.
Non-rapid eye movement sleep (slow wave sleep) has 4 stages, entering deeper sleep phase by phase. The 1st stage of slow wave sleep is the contemplative sleep state. This stage precedes definite sleep and lasts only a few minutes. The next stage is stage 2, characterized by steady-state sleep. During this period, the response to non-painful external stimuli disappears. Stages 3 and 4, are experienced as deep sleep. Some experts combine these two stages into one, called “slow wave sleep”. Non-rapid eye movement sleep and rapid eye movement sleep make up one sleep cycle. Typically, a cycle lasts 80 to 100 minutes, and there are usually 4 or 5 cycles throughout the night.
The first REM sleep period occurs about 90 minutes after sleep and lasts 5—10 minutes; after that, it occurs again every 90 minutes or so and lengthens gradually; on average, 5 REM sleeps occur each night, with a total length of about 90—120 minutes (the time is not right?). . REM sleep in adults is about 25% of total sleep. The test wakes up a person at the end of REM sleep and he or she tells that he or she is in a dream state. Dreams at the beginning of sleep are dominated by memories of daytime experiences; dreams in the middle appear to be of past events; and the final dreams have a mix of past and recent events that last longer.
However, as late night approaches, the relative amount of rapid eye movement sleep increases and the relative amount of slow wave sleep decreases. Very much of REM sleep occurs in the second half of the night, while most slow-wave sleep occurs in the first half of the night. REM sleep is a unique state characterized by rapid eye movements and extreme reductions in heart rate, respiratory rhythm, extensive variability in blood pressure and mutually inconsistent muscle tone. Most dreams occur during this phase of sleep. Some studies suggest that lack of REM sleep disrupts near-event memory. REM sleep is very important for memory and learning processes. This phase of sleep is associated with dreams, and brain activity during REM sleep is related to previously acquired information. REM sleep may also be associated with mood, creativity and sexual function. It can be said that each sleep period has its own unique function for the organism.
Human sleep and wakefulness show an inherent rhythm, with the natural sleep period of REM sleep, when the whole body muscles are completely relaxed, and the slow wave sleep period, when the brain and peripheral nerves are fully rested. During 8 hours of sleep, REM sleep alternates with slow-wave sleep 4-6 times. At the end of each cycle, when a new cycle is about to be entered, the brain waves show low amplitude and desynchronization changes. This is the fast-acting phase or dreaming phase of the person.
REM sleep accounts for 50% of infants, 30-40% of young children up to 2 years old, 20-25% of adolescents and adults, and less than 5% of the elderly. In adults, slow-wave sleep lasts for 90 minutes and fast-wave sleep lasts for 30 minutes, alternating between fast and slow, and both types of sleep can lead directly to the waking state; however, to enter fast-wave sleep from the waking state, one must first enter slow-wave sleep. The closer to the late stage of sleep, the longer the duration of FPS. Dreaming is mainly in the RW sleep period, and a few in the slow wave sleep period. There is a difference between the dreams of the two sleep periods: the dreams of slow-wave sleep are more conceptual and involve recent life events; the dreams of fast-wave sleep are more perceptual (especially visual perception) and have vivid and eccentric contents.
Slow-wave sleep has a restorative effect on health. Healthy adult men experience increased growth hormone release during slow-wave sleep, and increased functional activity of other components of the immune system, which contributes to mental health.
The typical anxious patient is often exhausted by the difficulty of falling asleep. The more you worry about insomnia, the more difficult it is to fall asleep. When you hear others breathing evenly, you can’t fall asleep. So think of all kinds of ways to count, play music……. I have to take medicine, but I am worried about the side effects of drugs, eat a piece, can not sleep. The two hours of insistence still can not sleep, feel the long night is difficult, so eat another piece, so easy to sleep for a while. Before the effects of the drug wore off, it was already dawn and time to go to work. I got up in a daze and had no energy for the rest of the day. During the day, I was desperate to find a place to sleep. At night, the torment of insomnia begins again…… anxiety is not controlled, the problem of insomnia will not be solved naturally.
A person’s healthy sleep is greatly related to work safety. Insomnia is a symptom of persistent, unsatisfied quality and quantity of sleep. Difficulty falling asleep, difficulty maintaining sleep and early awakening, or both conditions coexist. By measuring the quality of sleep (sleep structure) and the state of various physiological functions, polysomnography simultaneously records data such as brain waves, heart rate, respiration, blood oxygen saturation, electromyography and eye activity of a person during sleep, and determines whether a person’s sleep is normal or abnormal by an automatic analyzer.
Abnormal sleep makes the body lack of timely recovery and adequate nutrition (as the saying goes, if you don’t sleep well, you can’t eat well), leading to rapid cellular aging, which is actually a constant overdraft of life. Once the body’s aging exceeds a certain limit, various diseases will rise sharply, anxiety, headaches, neurasthenia……… , the person will be stoned into trouble. Take sleeping pills after sleep also does not relieve fatigue. From the analysis of physiological principles, the sleep caused by sleeping pills can not completely replace the natural physiological sleep.
I often hear patients in the clinic say that they always dream all night; I also often hear people say that they never dream all night. In fact, neither of these is objective. The truth is that everyone dreams, and the number of dreams is relatively constant. But the vast majority of dreams are forgotten. This is because there are great individual differences in the recall of dreams. People who can sleep until dawn usually cannot remember the dreams of the first half of the night. Only the last dream of the second half of the night can be recalled. The recall of dreams is related to personality traits. Introverted people are more vivid in their dream recall because they are very aware of what is happening around them. Anxious people, who are always in a state of stress, are more alert to sleep than the average person and seem to have a clearer recollection of dreams than the average person. The greater clarity makes the anxious patient remember more of a dream to the point of believing that he or she has been dreaming all night and has not slept. The reason for forgetting is mainly the time factor. Most people who are awakened during REM sleep can recall the dream they just had, and if they are awakened 10 minutes after the end of the REM sleep period, most have forgotten the dream they had. Human dreams have a considerable “emotional load”——Early in the morning, people wake up naturally from sleep, feeling comfortable, relaxed and quick thinking.
Dreams are the second spiritual world of man. Dreaming not only helps the development of the central nervous system of the brain, but also provides a beneficial stimulus to the nerves of the brain so that the central nervous system adjusts to a state of readiness and the information of the brain is reorganized. Dreams are the continuation of people’s work and life. Dreaming is invariably closely related to thoughts, feelings, character, situations, etc. Those vividly colored images, light and strange scenes bring people to strange worlds, which greatly enrich people’s spiritual world. This is because people are more likely to receive tiny stimuli in their bodies during sleep than when they are awake, and those weak signals, which are not yet perceptible, cause excitement in the corresponding parts of the brain during sleep, so that a dream related to diseases appears. If you have repeated dreams with similar contents, it is often a precursor of suffering from a certain disease: often dreaming of someone or a monster knocking on the head or pouring or digging something into the five senses suggests a possible brain tumor, etc.; often dreaming of someone chasing and wanting to scream but being unable to do so suggests insufficient blood supply to the coronary arteries; often dreaming of a crooked or twisted body, accompanied by a feeling of suffocation and sudden awakening is a sign of angina; often dreaming of being locked in often dream that one is locked in a dark room and feels difficulty in breathing, or dream that one’s chest is pressed, suggesting lesions in the lungs or respiratory tract; often dream that one is kicked or stabbed from the back, and after waking up, one feels pain in the area that was kicked or stabbed, suggesting potential lesions in the lumbar region or kidneys; often dream that one eats rotten food and wakes up with a bitter taste in the mouth, or feels thirsty in the dream, suggesting gastrointestinal diseases; often dream that one’s legs or one leg is as heavy as a stone and cannot walk , suggesting a disease in the legs; dreaming that one is looking for a toilet everywhere is to make the urine swell; remembering the dream vividly after waking up every day indicates neurosis or weakening of the body.
Everyone will feel that they sometimes “ more dreams ” or sometimes “ less dreams ”. This mainly comes from the dream “recall power”, is the ability to recall the dream and attitude. Recall power in addition to the above time factors, but also with the person “s personality traits ” and “thinking style ” have a relationship. Some studies have shown that “ introverts are more likely to recall the dreams they have had, while extroverts are the opposite. Introverts are more concerned about the complex connections in their inner world.
There is a Dr. Hudson (Hudson) will be human thinking into two major types: 1, convergent thinking. It is the thinking mode of scientific workers, referring to the ability to use logical reasoning, from a variety of phenomena to sum up a conclusion method of inference. Less likely to tell or recall the dreams they have, even if they know the dream, the dream will not be distinct. 2, divergent thinking. It is the intentional characteristic of art workers, referring to the ability of rich imagination and expression, close to the individual performance talent we understand in real life, and they can recall many more vivid dreams.
Generally speaking, each of us has at least 4-5 dreams a night, 1500 dreams a year, and more than 100,000 dreams in our lifetime. Life 1/3 used to sleep, and sleep 1/5 used to dream, dream is our “ one fifteenth of life ”. Different people show different dreams, different people show different “recall power ” to dreams. The analysis of dreams is a permanent and in-depth subject.
It is important to know that the brain is still active during sleep, preparing for the next day’s awakening and optimal state; boredom makes sleepiness more obvious; lying in bed with eyes closed does not satisfy the need for sleep; snoring exists as a sleep disorder; people dream every night; the elderly have little change compared to their youth, except that they sleep less at night and more during the day; sleep disorders are caused by a variety of factors: disease, genetics, worries and Psychological disorders, etc.; the human body cannot be fully adapted to work at night; all bodies have physiological cycles; the twenty-four lunar seasons affect the turnover of sleep and wakefulness; when crossing time zones to adjust their physiological rhythms according to the changes in jet lag…….
The Columbia University Research Center suggests that the former may have a greater impact on weight when sleep is reduced compared to increased physical activity. People who are deprived of sleep have lower levels of leptin and higher levels of a hormone that stimulates appetite, thus leading to increased appetite. That is, the less sleep you get the more obese you become.
Sleeping pills cause sleep by paralyzing the nerves in the brain, so it is called passive sleep. Natural sleep is controlled by the human “biological clock” and has its own inherent, alternating fast-wave sleep and slow-wave sleep. Passive sleep occurs after taking medication and only increases slow-wave sleep and decreases fast-wave sleep, so the whole body muscles and brain can only get partial rest. Many people who fall asleep with sleeping pills for a long time are light sleepers, and are prone to waking up from dreams. Therefore, people who fall asleep with sleeping pills for a long time still feel sleepy, weak, depressed, and have memory loss after waking up. Long-term use of sleeping pills interferes with the body’s normal physiological rhythm of sleep and can subtly change the body’s physiological functions and mental mood. In particular, long-term, single use will also appear drug dependence, once the drug is stopped, withdrawal syndrome will occur, dizziness, dizziness, difficult insomnia, nausea and vomiting, mania and anxiety, tremors, and even convulsions, convulsions, and even seizures. Therefore, the exact cause should be sought and appropriate medication should be selected.
In recent years, research has confirmed that there is some connection between insomnia and some hormones. Many insomnia patients take
melatonin, which can be taken in doses 10 times higher than their physiological melatonin. Studies have shown that melatonin use at a median dose of only 3 mg can restore normal sleep. The use of melatonin must be individualized (i.e., different for each person) and patients should work with their physicians to select the exact dose of melatonin to use.
The treatment of insomnia includes: 1. pay attention to sleep hygiene, develop good habits, and form a regular sleep schedule; increase appropriate sports. 2. non-drug insomnia treatment: behavioral therapy, relaxation therapy, paradoxical intention training, morita therapy, cognitive therapy, etc.
(1) Behavior therapy. Its theoretical basis: most of human behavior is acquired by acquired learning, maladaptive behavior is the result of mislearning. Through certain techniques and enhanced training, the maladaptive behavior is abandoned and a healthy behavior is re-established. Behavior therapy operates as follows: First, improving poor sleep habits (without the help of hypnotic drugs) is the best treatment. Some patients have had insomnia for a long time, and the cause of the insomnia no longer exists at the time of the visit, but they have developed bad sleep habits. Lying in bed, they start to go through “movies”, thinking over what others said during the day, their own behavior, in detail, angry, remorseful, excited, and eventually insomnia again. For this kind of insomnia patients, it is recommended that they do not go to bed if they are not sleepy, and go to bed. The habit of thinking does not take place in bed. Over time, re-establish a good sleep habit. If this still doesn’t work, try sleep restriction therapy: by inducing artificial sleep deprivation, the organism enhances its ability to fall asleep and maintain sleep. For example, if someone sleeps only 5 hours a night for more than 2 weeks and wakes up naturally at 7:00 am every morning. In the first week of sleep restriction therapy, the patient goes to bed at 2:00 a.m.; in the second week, he or she goes to bed 15 minutes earlier each night, but still wakes up at 7:00 a.m. sharp. And so on, going to bed 15 minutes earlier each week. Patients kept track of sleep times and were in regular contact with their physicians. The goal of sleep restriction therapy is to achieve a sleep efficiency rate of 85% (sleep efficiency means total sleep time equals total bedtime), which is usually achieved after 8 weeks.
Also, worrying about sleep difficulties can worsen insomnia. Patients with insomnia have developed a fear of sleep after a period of insomnia. Often, they are already nervous before they go to bed. So they toss and turn in bed and become more and more unable to fall asleep. For this anxiety before going to sleep, relaxation therapy can be performed.
The ideal amount of sleep varies from person to person, with some people needing 10 hours and others needing only 3 hours. As people age, the time needed for sleep decreases accordingly; everyone’s sleep is inconsistent; occasional insomnia for a few nights is not harmful; everyone has experienced occasional insomnia, especially in stressful situations.
(2) Paradoxical intention training. Some insomniacs slept well the first night after polysomnographic EEG. One of the theories to explain this phenomenon is that because they have established a learned maladjustment between sleep and wakefulness in their daily lives, this connection normally affects sleep, but in the laboratory this connection is not expressed. Some people do not make an effort to fall asleep in the laboratory in order to prove that they are sick. As a result, there is no anxiety and instead they sleep well.
Ambivalent intention training is asking the patient to do the opposite, which in layman’s terms means that the patient does what he or she does not want to do. Patients are so tormented by insomnia that their greatest fear is to go to sleep, then they don’t go to sleep. If they are really not going to sleep, anxiety is instead reduced and falling asleep becomes possible.
(3) Morita therapy. Morita therapy was created in the 1920s to relieve patients of mental boredom and distress through periods of bed rest, light work, heavy work, and social rehabilitation. This therapy clarifies the original psychological structure of human desires, restlessness and emotions. It requires going with the flow and learning to live with the restlessness and conflicts that are inherent in life. Emphasis is placed on living each day of life, not eliminating the angst, but doing what life should do with the angst. Morita therapy emphasizes adjusting the patient from the outside inward in real life, tawning character, through the treatment, the patient no longer indulge in internal pain and entanglement due to the outward projection of attention, the anxiety level decreases, so that the patient’s psyche produces “epiphany”, symptom reduction and relief.
(4) Cognitive therapy. Patients subjectively recognize and acknowledge depression and anxiety. First, most depressed patients
Most depressed patients are ignored or avoided because of their mild symptoms. In their eyes, depression is someone else’s business and has nothing to do with them.
Second, many patients see depression as weakness in the face of mental stress and have a sense of shame. In order to prove that they are strong, they would rather endure the dysfunction of their organs caused by long-term depression. They spend a lot of money on treatment of physical organs, but not on mental treatment. They do not understand that man is a psychobiological whole and many depressions arise as a common psychobiological reaction in the face of mental stress. Therefore, any fluctuation of feelings causes a corresponding change in the chemical composition of the nervous system. The reaction and processing of any person to mental stimuli is manifested on both physical and psychological planes. People have to endure and face numerous difficulties and hardships in their life. Only by treating mental illnesses like physical illnesses can symptoms be transformed scientifically and effectively. Relieving and reducing depression and anxiety can be a major preoccupation of insomnia treatment.
“I can’t sleep at night, and wake up too early in the morning, because then I feel tired and can’t get interested in doing anything. If I could sleep, I would be fine. My problem is sleep. ” DD This is the most common explanation for: “insomnia with depression and anxiety” heard in outpatient clinics.
It is painful to acknowledge depression and anxiety, but it is even more painful to deny it. If sleep does not improve with non-pharmacological treatment, we then consider pharmacological treatment. Pharmacological treatment allows patients to reduce over-excitement, tend to be quiet, and easy to fall asleep; can maintain a longer period of sleep close to the physiological requirements; short-term application of sedative and sleeping drugs help to properly relieve symptoms, should be selected from drugs with a short half-life, and applied from small doses.