I. The main manifestations of insomnia
1. Difficulty in falling asleep: It is difficult to fall asleep even after half an hour or even 1~2 hours in bed. Mostly seen in people with anxiety or important life events.
2, shallow sleep, easy to wake up, dreamy type: wake up more than 3-4 times a night, it is not easy to fall asleep after waking up. Waking up 15%-20% of the sleep time each night, normal people generally do not exceed 5%. Mostly seen in individuals with nervous personalities.
3.Early awakening type: Mostly wake up at 3~4 am, and cannot fall asleep after waking up. Mostly seen in patients with depression.
Second, the common causes of insomnia
1.Stress factors: Considering work, school, health or family problems can make your brain still in an excited state at night, making it more difficult to fall asleep. Stressful life events, such as the death or illness of a loved one, divorce, unemployment, etc., can cause insomnia.
2. Anxiety: Daily anxiety as well as higher levels of anxiety (e.g., post-traumatic stress disorder) may interfere with your sleep. Worrying about whether you can fall asleep adds to the difficulty of falling asleep.
3, depression: Depression may manifest itself in the form of excessive sleep or insomnia. Insomnia also often occurs with other mental disorders.
4. Somatic disorders: If you have chronic pain, breathing difficulties or need to urinate frequently at night, this may cause insomnia. Somatic diseases related to insomnia include: arthritis, cancer, heart disease, lung disease, gastroesophageal reflux disease, hyperthyroidism, stroke, Parkinson’s disease and Alzheimer’s disease.
5. Changes in environment and work: Travel or shift work can disrupt your biorhythms and cause difficulty sleeping. Your biorhythm is the biological clock, which regulates the sleep-wake cycle, metabolism and body temperature.
6, bad sleep habits: Bad sleep habits include: irregular sleep, strenuous activity before bed, uncomfortable sleep environment, doing things in bed other than sleeping and couple life.
7, drugs: Many prescription drugs can affect sleep, including some antidepressants, heart and blood pressure medications, anti-allergy drugs, central stimulants (such as Ritalin), glucocorticoids. Many over-the-counter drugs, including pain combinations and some weight-loss drugs, also contain caffeine and other excitatory ingredients that also affect sleep.
8, caffeine, nicotine and alcohol: coffee, tea, cola and other caffeinated beverages are excitatory. Drinking coffee or tea in the afternoon or evening may interfere with sleep. Nicotine in tobacco can also cause insomnia, and it is worth mentioning that alcohol, although it may help with sleep, does not allow people to enter deep sleep, and you often wake up in the middle of the night.
9, dinner is too full or too late: dinner is too full or too late may feel sick after lying down, it is difficult to sleep. Many people are often affected by heartburn, acid reflux, etc. to fall asleep.
10, some factors related to insomnia: women (pregnancy, postpartum, menopause, etc.), age greater than 60 years, brain workers, etc.
Third, suffering from insomnia how to do
Insomnia is caused by a variety of reasons, so the treatment of insomnia should treat the cause of insomnia. When insomnia occurs, you should seek the help of a professional doctor to find the cause of insomnia as much as possible, so as to treat the symptoms, and avoid taking health care products and drugs indiscriminately.
At the time of consultation, you should provide your doctor with: specific sleep status, medication history, and whether you smoke or drink alcohol, and your doctor will conduct a physical examination and mental and psychological status assessment as appropriate. The details of the sleep status information obtained include the form and duration of insomnia, the presence or absence of triggers, work and rest patterns, sleep-related symptoms and the impact of insomnia on daytime functioning.
Your doctor will prescribe medication, behavioral training, psychotherapy, physical therapy, etc. based on your specific presentation and examination results. It should be noted that there are many kinds of medications for insomnia, and whether you need medication intervention and which medication you need to take need to be diagnosed and treated by professional doctors.
Non-pharmacological treatment for insomnia
Non-pharmacological treatment for insomnia mainly includes psychological behavior therapy, transcranial magnetic stimulation, acupuncture, diet therapy, aromatherapy, massage, homeopathy, light therapy and so on. Among them, psycho-behavioral therapy is more effective, and the effective psycho-behavioral therapy for insomnia is mainly cognitive-behavioral therapy. Transcranial magnetic stimulation technology is based on the principle of electromagnetic induction and electromagnetic conversion, stimulating neurons to produce a series of physiological and biochemical reactions, which is a non-invasive stimulation technology without direct contact with the human body, easy and safe to use. Some studies have found that repetitive transcranial magnetic stimulation (rTMS) has the effect of improving sleep and sleep quality, and it is widely used at present.
V. Psycho-behavioral treatment of insomnia
The essence of psycho-behavioral therapy is to change the belief system of the patient and bring into play his or her self-efficacy, thus improving insomnia symptoms. To accomplish this goal, the involvement of a medical professional is often required. Psychobehavioral treatments are effective for primary and secondary insomnia in adults and often include sleep hygiene education, stimulus control therapy, sleep restriction therapy, cognitive therapy, and relaxation therapy. These approaches are used either independently or in combination for the treatment of primary or secondary insomnia in adults.
1. Sleep hygiene education: Most insomnia patients have poor sleep habits that disrupt normal sleep patterns and form a wrong concept of sleep, which leads to insomnia. Sleep hygiene education is mainly to help patients understand the important role of bad sleep habits in the occurrence and development of insomnia, analyze the causes of forming bad sleep habits and establish good sleep habits. The content of sleep hygiene education includes.
(1) Avoid excitatory substances (coffee, strong tea or smoking, etc.) a few hours before bedtime (after 4 p.m.);
(2) Do not drink alcohol before bedtime, as alcohol can interfere with sleep;
(3) regular physical exercise, but avoid strenuous exercise before bedtime;
(4) Do not eat and drink or eat indigestible food before bedtime;
(5) at least one hour before bedtime do not do excitable mental work or watch excitable books and television programs;
(6) bedroom environment should be quiet, comfortable, light and temperature appropriate;
(7) Maintain a regular work and rest schedule.
2, relaxation therapy: stress, tension and anxiety are common factors that induce insomnia. Relaxation therapy can alleviate the adverse effects of the above factors, so it is the most commonly used non-pharmacological treatment for insomnia, the purpose of which is to reduce the alertness when lying in bed and reduce nighttime awakenings. Technique training to reduce arousals and promote nighttime sleep includes progressive muscle relaxation, guided imagery, and abdominal breathing exercises. Patients planning relaxation training should practice consistently 2-3 times a day in a neat and quiet environment, initially under professional supervision. Relaxation therapy can be used as an independent intervention for insomnia treatment (Level I recommendation).
3.Stimulation control therapy: Stimulation control therapy is a set of behavioral interventions to improve the interaction between sleep environment and sleep tendency (sleepiness), restoring the function of bed as a sleep-inducing signal, making it easy for patients to fall asleep and reestablishing the sleep-wake biorhythm. Stimulus control therapy can be applied as a stand-alone intervention (level I recommendation) for.
(1) Go to bed only when sleepiness is present;
(2) If you cannot fall asleep after 20 minutes in bed, leave the bedroom, engage in some simple activity, and return to the bedroom when you feel sleepy;
(3) Do not do activities in bed that are not related to sleep, such as eating, watching TV, listening to the radio and thinking about complex problems;
(4) Maintain a regular waking time, regardless of how long you have slept the night before;
(5) Avoid taking naps during the day.
4.Sleep restriction therapy: Many insomnia patients try to increase the chance of sleep by increasing the time of bed rest, but it is often contrary to their wishes, but the quality of sleep is further reduced. Sleep restriction therapy increases the drive to sleep by shortening the time spent awake in bed to improve sleep efficiency. The recommended sleep restriction therapy is as follows (Level II recommendation): (1) reduce bedtime to match actual sleep time and increase bedtime by 15-20 min only if sleep efficiency exceeds 85% for 1 week; (2) reduce bedtime by 15-20 min when sleep efficiency is below 80%, and keep bedtime the same when sleep efficiency is between 80% and 85%; (3) keep bedtime the same when sleep efficiency is below 80%. (3) avoid daytime naps and keep regular waking time.
5, cognitive behavioral therapy: insomnia patients are often fearful of insomnia itself, overly concerned about the adverse consequences of insomnia, and often feel nervous and worried about sleeping well when they are close to sleep, these negative emotions make sleep further deteriorate, and the aggravation of insomnia in turn affects the patient’s mood, forming a vicious circle between the two. The purpose of cognitive therapy is to change the patient’s cognitive bias about insomnia and to change the patient’s irrational beliefs and attitudes about sleep problems. The basic elements of cognitive behavioral therapy are.
(1) Maintain reasonable sleep expectations;
(2) Do not blame all problems on insomnia;
(3) Maintain natural sleep and avoid overly subjective sleep intentions (forcing oneself to fall asleep);
(4) Don’t focus too much on sleep;
(5) Don’t get frustrated because you didn’t get a good night’s sleep;
(6) Develop tolerance for the effects of insomnia.
VI. Common problems and misconceptions about insomnia
1. Drinking alcohol can help you sleep
Many people drink alcohol and often take advantage of the strength to fall asleep to cope with insomnia. It is true that alcohol can shorten the time to fall asleep and can fall asleep quickly, but deep sleep and fast wave sleep time is significantly reduced, and it is likely to wake up frequently in the second half of the night because the body’s alcohol content is gradually metabolized and reduced, and sleep will be intermittent. Alcohol is also a diuretic, causing an increase in the frequency of getting up at night to urinate, which also interferes with sleep. Alcohol also relaxes the neck muscles and affects the brain control mechanism, it makes snoring worse for snorers and exacerbates some other nighttime sleep breathing problems. If a large amount of alcohol is consumed over a long period of time it may also cause alcohol-dependent sleep disorders.
2, hypnotic drugs can be addictive, do not dare to eat
Sedative-hypnotic drugs are very effective drugs to help sleep and improve sleep, and most sedative-hypnotic drugs do not belong to the psychotropic drugs, so the safety is high. This type of medication should be taken on an “as needed” basis. The doctor will help the patient to choose the right medication according to the patient’s physical condition and different requirements for sleep.
It is not scientific to refuse to take medication or to take medication at will. For patients with chronic insomnia, if they still need medication to maintain sleep for a longer period of time, they must take the medication as prescribed by the doctor and follow up regularly in the clinic. It is very safe to take hypnotic drugs routinely under the guidance of a doctor.
3, dreaming a lot of sleep is not good
Many people have a lot of dreams, many of them will think they have insomnia, worry about the results of insomnia, so that they are more anxious, the more the dreams increase. Dreaming is a normal physiological phenomenon, dreams can in fact be seen as a part of the sleep process, only when you fall asleep will you dream, without ever falling asleep, there will be no dreams at all. Simply put, everyone sleeps and dreams, but some people dream more and some people dream less. Some people dream so realistically that they can remember when they wake up; others dream so slowly that they don’t remember when they wake up. People who claim that they never dream actually have dreams, but their dreams are less realistic and less realistic, and they don’t leave an impression.
Is excessive dreaming pathological? Objectively speaking, excessive dreaming is usually not harmful to sleep, and does not need to be dealt with. But if the nightmares are so bad that people wake up several times a night, it is not good, if this is often the case, you should seek help from a specialist.
Why do some people have more dreams and others have fewer? It is not fully understood. Several factors are known, including: congenital constitution, mental stress, age and the influence of drugs, etc. If you are troubled by this, you should consider these matters to deal with. However, it is best to establish the correct concept, not to think that the disease, less worry, and no longer have “more dreams, sleep, will be tired” of self-suggestions, mental stress once removed, the dream will be reduced.
Medication is not the best solution, most sedatives or sleeping pills or even cold medicine or muscle relaxants will only make people dream more, so do not buy your own medicine to take, so as not to be counterproductive.