For the average adult, nearly half of the population has suffered from insomnia at one time or another. However, most people do not think of it as a disease, and even fewer seek medical attention for it or are able to talk about sleep problems voluntarily when they do. We have found that many insomnia patients are “accidentally” discovered to be the culprit when they go to neurology after chronic insomnia has led to chronic dizziness and other symptoms. Ms. Zhang, a 56-year-old woman, had been seen six times for dizziness, and each time her dizziness improved after treatment with infusion. However, this time the dizziness lasted longer than the previous times and could not be relieved after the infusion. Ms. Zhang is usually anxious, and since she retired home at age 50 and went through menopause, she often sleeps poorly. At first she took Valium intermittently, and later one capsule of Scholastin per day, which has been maintained for more than 4 years. Recently, Ms. Zhang complained to her doctor that the sleeping pills in her hand were not working well, and that one to two capsules of Valium had no effect even after adding four capsules. Ms. Zhang, who never thought that insomnia needed medical treatment, did not admit that she had any psychological problems, but only because of intermittent dizziness, mental confusion and poor memory over the past two years, she thought that it was due to insufficient blood supply to the brain, so she frequented neurology clinics and Chinese medicine clinics. Because of the unsatisfactory treatment of dizziness and the combination of insomnia, the neurologist suggested that she come to our psychology department for a checkup. After Ms. Zhang came to our department, she underwent a mood scale and autonomic function tests, which showed moderate to severe depression and anxiety. Ms. Zhang was shocked by this result. After the doctor-patient communication and joint discussion, Ms. Zhang listened to the clinical psychologist’s advice and adopted a combination of medication combined with cognitive-behavioral psychotherapy and biofeedback therapy. 1 month later, Ms. Zhang’s dizziness improved significantly, and two months later, she did not take any more sleep-promoting drugs and her emotional and social functioning returned to normal. After 1 year of follow-up after treatment, Ms. Zhang’s sleep condition improved significantly without fluctuation and dizziness did not recur. ★Doctor-patient dialogue ■Patient question: What is insomnia and chronic insomnia? ▪Patient question: What is insomnia and chronic insomnia? Chronic insomnia is defined as having more than 3 episodes of insomnia per week for more than 6 months. The main clinical symptoms accompanying patients with chronic insomnia are: dizziness, headache, blurred vision, tinnitus, palpitations, shortness of breath, fatigue, irritability, and lack of concentration. Chronic insomnia not only affects daytime work and energy, but also contributes to hypertension, diabetes, obesity and heart attacks, and can also increase the risk of stroke, as well as the risk of depression. Patient question: What are the causes of chronic insomnia? ■Visiting physician: The first step is to identify insomnia caused by somatic diseases. Almost all diseases interfere with the original sleep pattern and affect the rhythm of sleep and wakefulness, and insomnia will be solved when the primary disease is cured. Secondly, drugs are also an important factor in causing insomnia, such as antihypertensive drugs, corticosteroids, caffeine, etc. can affect sleep. It is worth noting that improper long-term application of drugs can also interfere with sleep. The most common causes of chronic insomnia are emotional disorders and chronic abuse of sleeping pills or alcohol consumption. Insomnia in anxious patients is characterized by a significant decrease in sleep density, mainly manifested by difficulties in falling asleep and less deep sleep; insomnia in depressed patients is characterized by an increase in the temporal transition between the phases of sleep, mainly manifested by early awakening and an increase in the number of awakenings. Patient question: Is it possible to get addicted to sleeping pills? ▪ The doctor: Most sleeping pills are safe, and addiction is very low. Currently, in order to address the addictive nature of sleeping pills, the World Health Organization states that it is best to use any one sleeping pill for no more than 4 weeks as prescribed by a doctor. The clinical recommendation is that the same sleeping pill should not be taken for more than 2 to 4 weeks. Therefore, addiction can be avoided by using sleeping pills rationally and changing them regularly (2~4 weeks). In addition, common side effects of sleeping pills include dizziness, drowsiness, lack of concentration, and unstable walking, which doctors call “hangover reaction”, that is, like drinking at night and not waking up the next day. In this case, the patient should lower the dose of the medication or switch to another medication under the guidance of the doctor. Patient question: What are the principles of using medication to treat chronic insomnia problems? ■Visiting physician: Benzodiazepines? The drugs of the class (sleeping pills) are relatively safe when taken for a short period of time under the guidance of a doctor. The hypnotic effect may decline only when the drug is applied continuously for 4 to 12 weeks. Long-term application may produce tolerance and dependence, and insomnia may worsen after stopping the drug. Some chronic insomniacs who have to take benzodiazepines for a long period of time are better off taking them alternately or in combination with other drugs. It is best to use alternate or intermittent medication method, such as holiday medication: take medication every Friday and Saturday night, and no medication at other times. This avoids the development of drug tolerance and allows the patient to get adequate sleep at least one or two nights a week, essentially eliminating the adverse effects of insomnia. For depression or anxiety combined with chronic insomnia, it is important to be aware of the problems that tend to occur with the use of sedative-hypnotic drugs alone when administering medication. This is because while this can improve the patient’s sleep problems in the short term, it can mask or even further aggravate the emotional disorder. Patient question: Why should patients with chronic insomnia be seen in a clinical psychology department? ▪Patients with insomnia often ask their doctors, “I don’t have any psychological problems, so why should I go to the psychology department instead of the neurology department? In fact, insomnia itself falls under the category of psychological disorders. In some patients with chronic insomnia, insomnia is only a symptom, but fundamentally it may be a symptom of anxiety or depression, so it is important to go to a clinical psychology department for a systematic evaluation by a specialist to rank psychiatric-psychological disease-related insomnia. Patients with depression producing secondary insomnia must be treated with additional antidepressants. When patients with anxiety disorders produce secondary insomnia, treatment with anti-anxiety medication is added.