The concept of insomnia
Insomnia: refers to the difficulty in falling asleep and maintaining sleep. Insomnia is a kind of sleep disorder. The complaints of insomnia include difficulty in falling asleep, easy to wake up at night or early in the morning, difficulty in falling back to sleep after waking up, feeling tired or lack of wakefulness after waking up, etc. Patients have daytime sleepiness, along with headache, palpitations, forgetfulness, irritability and other symptoms.
Treatment guidelines
To improve sleep quality and/or increase effective sleep time, restore social function, improve the patient’s quality of life, and reduce or eliminate the risk of somatic diseases associated with insomnia or co-morbidities with somatic diseases.
Pharmacological treatment
Non-benzodiazepine drugs are recommended for general treatment: e.g., eszopiclone, zolpidem, zolpidem controlled-release, zopiclone, etc. It is important to visit a specialist for the treatment of insomnia and take the medication as prescribed by the physician.
Other treatments
1.Psycho-behavioral treatment
The main effective psycho-behavioral treatment for insomnia is cognitive-behavioral therapy. Psycho-behavioral therapy is effective for primary and secondary insomnia in adults and usually includes sleep hygiene education, stimulus control therapy, sleep restriction therapy, cognitive therapy and relaxation therapy. These methods are used either independently or in combination for the treatment of primary or secondary insomnia in adults.
2.Physical therapy
Repetitive transcranial magnetic stimulation is a new non-pharmacological option for insomnia treatment, which can be combined with medication to rapidly block the onset of insomnia, and is particularly suitable for the treatment of insomnia in women during breastfeeding, especially insomnia caused by postpartum depression.
3.Relaxation therapy
Relaxation is an effective treatment for insomnia. The method is to gradually relax and tense different muscle groups throughout the body. This method is very effective for insomnia patients who remain highly alert throughout the day.
4.Contradictory intention therapy
Ambivalent intention therapy is to persuade insomnia patients to engage in their most feared sleep behavior, i.e., not sleeping. The main purpose of this therapy is to eliminate anxiety, which can inhibit sleepiness. If the patient stops trying to fall asleep and instead remains awake naturally, this will reduce anxiety symptoms and may instead make it easier to fall asleep. It is unclear which type of insomnia is appropriate for the patient, as the response to this therapy varies.
5.Biofeedback therapy
Biofeedback therapy provides patients with visual and auditory feedback to help them control certain physiological factors (e.g., muscle tension) to reduce somatic arousal.
6.Sleep restriction therapy
Sleep restriction therapy is mainly to shorten the total time the patient stays in bed, limiting the patient’s sleep time to the time he or she actually falls asleep. Sleep restriction therapy has a mild sleep deprivation effect, which can speed up the patient’s sleep, improve sleep efficiency and reduce the fluctuation of the disease. To prevent excessive daytime sleepiness, the sleep duration should not be less than 5 hours per night.
7.Integrated (cognitive) behavioral therapy
Integrated (cognitive) behavioral therapy is a treatment method that combines psychotherapy and behavioral therapy. The purpose of psychotherapy is to change the patient’s perception and attitude towards insomnia. Behavioral therapy includes stimulus control, sleep restriction and relaxation therapy. Since integrative therapy is now increasingly commonly applied as a holistic model, it is classified as a separate category.
8.Sleep hygiene education
The purpose of sleep hygiene education is to improve the quality of sleep by making patients more aware of which health care measures and environmental factors may have harmful or beneficial effects on sleep.
9.Imagination training
Imagery training is to allow the patient to imagine certain pleasant or unemotional images. This therapy is actually a branch of relaxation therapy.
10.Cognitive therapy
Cognitive therapy seeks to change the patient’s perception and attitude towards sleep. The goal is to reduce the vicious cycle of insomnia, affective depression, cognitive dysfunction and further sleep disorders.
The perceptions corrected by cognitive therapy include.
(1) Unrealistic expectations of sleep.
(2) Misconceptions about the causes of insomnia.
(3) Exaggerated consequences of insomnia.
(4) Symptomatic anxiety caused by attempts to control the sleep process.
11.Phototherapy
The basis of light therapy is that the retinal thalamus transmits light information to the suprachiasmatic nucleus, thus synchronizing the body’s internal “circadian pacemaker” with the light and dark cycles. Light therapy is more effective for sleep-phase advance syndrome and sleep-phase delay syndrome. The efficacy of light therapy for jet lag syndrome, shift syndrome, and non-24-hour sleep-wake syndrome is less certain, but can be used.