Insomnia is the most common type of sleep disorder in clinical practice. Long-term insomnia can have a negative impact on our individual normal life and work, especially affecting daytime cognitive function and seriously affecting our quality of life.
The overall goals of insomnia treatment.
1.Improve sleep quality and/or increase effective sleep time;
2.To restore social function and improve the quality of life of patients;
3.Reduce or eliminate the risk of somatic diseases associated with insomnia or co-morbidities with somatic diseases;
4.Avoid the negative effects that drugs dare to bring.
The treatment of insomnia mainly includes pharmacological and non-pharmacological treatments, and the effective psycho-behavioral treatment for insomnia patients is mainly cognitive-behavioral therapy.
The essence of psycho-behavioral therapy is to improve the patient’s belief system, to bring into play the patient’s self-efficacy, and thus to improve insomnia symptoms. Psychobehavioral therapy usually includes sleep hygiene education, stimulus control therapy, sleep restriction therapy, cognitive therapy and relaxation therapy.
I. Sleep hygiene education: Most insomnia patients have poor sleep habits that disrupt the normal sleep pattern and form a wrong concept of sleep, leading to insomnia. Sleep hygiene education mainly helps insomnia patients to recognize the important role of bad sleep habits in the occurrence and development of insomnia, and analyze and find the reasons for forming bad sleep habits. Thus, good sleep habits can be established.
What are the contents of sleep hygiene education?
1.A few hours before bedtime (usually after 4 pm), avoid using excitatory substances such as coffee, strong tea or smoking, etc;
2, do not drink alcohol before bedtime, alcohol can interfere with sleep;
3, regular physical exercise, but before bedtime should avoid strenuous exercise;
4, do not eat and drink or eat indigestible food before bedtime;
5, at least one hour before bedtime do not do mental work or observe books and films that are likely to cause excitement;
6, the bedroom environment should be quiet, comfortable, light and temperature appropriate;
7.Keep a regular resting time.
Second, relaxation therapy: stress, tension and anxiety are common causes of insomnia, relaxation therapy can alleviate the adverse effects of the above factors. Relaxation techniques mainly include: progressive muscle relaxation, guided imagery, and abdominal breathing training. Patients should practice them consistently 2-3 times a day, initially under professional guidance. Relaxation therapy can be used as a stand-alone intervention for insomnia treatment.
Third, stimulation control therapy: It is a set of interventions to improve the interaction between sleep environment and sleepiness, and restore the function of bed rest as an induced sleep signal, so that patients can easily fall asleep.
1.Only go to bed when there is sleepiness;
2.If you can’t fall asleep in bed for 20 minutes, you should get up and leave the bedroom, engage in some simple activities, and then return to the bedroom to rest when you feel sleepy;
3.Don’t do activities not related to sleep in bed, such as eating, watching TV, listening to the radio, thinking about complex issues, etc.
4.No matter how long you sleep the night before, keep a regular wake up time;
5.Avoid naps during the daytime.
Fourth, sleep restriction therapy: do not increase the opportunity to sleep by increasing the time spent in bed. Sleep restriction therapy usually shortens the time spent awake in bed and increases the drive to sleep to improve sleep efficiency.
1. Reduce the bedtime to match the actual sleep time, and only add 15-20 minutes if the sleep efficiency (actual sleep time/bedtime X 100%) exceeds 85% for a week
2. Reduce the bedtime by 15-20 minutes when the sleep efficiency is below 80%, and keep the bedtime constant when the efficiency is between 80% and 85%.
3.Avoid daytime naps and keep regular waking time.
V. Cognitive-behavioral therapy: The purpose is to change the patient’s cognitive bias about insomnia and to change the patient’s irrational concepts and attitudes about sleep problems.
1.Keep reasonable sleep expectation;
2.Don’t blame all the problems on insomnia;
3. Maintain natural sleep and avoid excessive subjective intention to fall asleep (forcing oneself to fall asleep);
4.Don’t pay too much attention to sleep;
5.Don’t get frustrated because you didn’t sleep well one night;
6. Develop tolerance for the effects of insomnia;
Cognitive-behavioral therapy usually includes cognitive therapy and behavioral therapy (stimulus control therapy, sleep restriction therapy), and can also be overlaid with relaxation therapy and sleep hygiene education, cognitive-behavioral therapy is the core of sleep psycho-behavioral therapy.