Insomnia is a problem that I often encounter in my clinical work. It may seem simple, but it is not, because insomnia is sometimes a precursor manifestation of a relapse or aggravation of a mental illness such as depression or schizophrenia, and sometimes it is the first manifestation of a disease, so correctly identifying insomnia and giving the appropriate treatment can help a lot in the recovery of the disease. Of course, simple insomnia is also very common. Many times, due to the lack of appropriate knowledge of patients, they are afraid to use sleeping pills because they are worried that they will become drug dependent, thus delaying timely and correct treatment and causing more pain to themselves and their families.
I wrote this article in the hope that we can understand insomnia, pay attention to insomnia, use the right medication, and ensure a better quality of sleep.
First of all, let’s understand the physiology of sleep.
Sleep is divided into eye fast moving sleep (REM sleep, also known as fast wave sleep) and non-eye fast moving sleep (NREM sleep, also known as slow wave sleep.) NREM sleep is divided into four stages, stage 1 is light sleep, stage 2 is moderate sleep, and stage 3 to 4 is deep sleep. We fall asleep and enter non-eye fast-acting sleep first, and then enter eye fast-acting sleep. One NREM sleep and one REM sleep make up one sleep cycle, and each sleep cycle lasts about 90 minutes.
REM sleep duration and 3-4 stages of NREM sleep determine the quality of sleep. The majority of dreams appear in the eye fast moving sleep, that is to say, a night’s sleep we have to do 4-6 times of dreams, dreams normally account for about 20% of the whole sleep time, so that everyone has dreams, dreams at night are normal, but we often do not realize it.
The role of dreams on the body is very important: 1.
1, dreams help to restore and strengthen the brain function.
2, dreams can bring pleasant memories (here refers to beautiful dreams).
3. Dreams can predict the occurrence of certain diseases.
4.Sleeping with dreams can prolong one’s life.
5.Dreams can increase people’s creative thinking.
6.Dreams help stabilize one’s mental state.
How long is it normal to sleep?
Generally speaking, the normal sleep time is 5 to 10 hours, children sleep longer, 9-10 hours or more, and adults sleep an average of 7.5 hours per night. Not everyone needs 8 hours of sleep, and less than 8 hours can be energetic. Regardless of how much sleep is available, sleep is normal as long as it ensures daytime productivity and the energy needed.
What is the role of sleep?
1.Protect the brain and restore energy.
2.Enhance immunity and rehabilitate the organism: Sleep can enhance the ability of the organism to produce antibodies, while sleep can also speed up the self-rehabilitation of various tissues and organs.
3.Promote growth and development: sleep is closely related to children’s growth and development, infants and children continue to develop their brains for a considerable period of time after birth, and this process cannot be separated from sleep; and children’s growth increases at a faster rate in the sleep state, so children should be guaranteed sufficient sleep to ensure their growth and development.
4, delay aging, promote longevity: healthy and long-lived elderly people have a good and normal sleep.
5.Protect human mental health: poor sleep leads to inattentiveness, while long time can cause unreasonable thinking and other abnormal conditions.
Does insomnia mean short sleep?
Insomnia is defined as a condition of unsatisfactory quality and quantity of sleep that lasts for a long time, manifested by difficulty in falling asleep, frequent waking up during the night, early waking up and not being able to fall back to sleep, or not relieving tiredness after waking up. The length of sleep is not the key, the key is the insomnia caused by daytime function, affecting the normal daytime activities, which is a necessary condition for insomnia.
According to the length of insomnia can be divided into:
1, transient insomnia: insomnia time within 1-6 days, mostly due to stress, sleep environment change and other factors, most of them can be relieved by themselves.
2, short-term insomnia: insomnia lasting 1-3 weeks is called short-term insomnia.
3.Long-term insomnia: insomnia lasts for more than 3 weeks, and the number of days of insomnia per week is more than 4. Many medical diseases, psychiatric diseases, or bad habits can lead to long-term insomnia.
According to the section of insomnia can be divided into:
1.Difficulty in falling asleep: difficulty in falling asleep refers to those who cannot fall asleep even after lying in bed for 30 minutes.
2.Easy to wake up: Easy to wake up refers to the increase in the number of awakenings or prolonged awakening time in the two hours after going to sleep. Usually the awakening time in sleep lasts less than 7 minutes, and when you wake up the next day, you cannot recall your awakening. However, frequent awakenings or excessively long awakenings can cause fatigue and irritability the next day.
3.Early awakening: Early awakening refers to waking up 1 to 4 hours earlier than normal sleep, resulting in less or insufficient sleep time. The cause is related to mental depression, depressed mood, etc. It is a characteristic insomnia of depressed patients.
The number of people with insomnia is increasing. Patients with insomnia are generally diagnosed as “neurasthenia”, “neurosis”, “depression”, “anxiety disorder “and so on. In fact, some patients with insomnia are related to lesions in the sleep structures of the brain, and insomnia should not be simply designated as a functional disorder. So, what brain lesions are related to insomnia?
1.Relationship with pineal gland
In the center of the brain, that is, the location of the midbrain: on the tegmentum, the corpus callosum pressure there is a spherical object called the pineal gland, which secretes two hormones, one is melatonin, the other is peptide hormones. Melatonin secretion has a distinct circadian rhythm, with a decrease in daytime secretion and an increase in nighttime secretion. When melatonin secretion decreases at night, insomnia will occur. In addition, melatonin secretion is related to sex hormone secretion. When the secretion of sex hormones increases, the secretion of melatonin decreases, thus causing less sleep.
For example, some teenagers are hypersexualized and have reduced sleep, which in turn reveals a pineal tumor. Pineal tumors can cause a decrease in melatonin secretion and an increase in sex hormone secretion. A recent case of a 60-year-old male patient who had suffered from insomnia for many years was aggravated for six months. He was diagnosed with “neurosis” despite the fact that he had been diagnosed with “pineal cysts” by MRI. The author read his medical history and asked him how his sex life was, and he replied: “I love it. The wife I just married is more than ten years younger than me.” I told him that cysts in the pineal region are the cause of insomnia and that treatment must be given for this condition in order to cure insomnia. After a physiological dose of melatonin to promote sleep and conservative treatment with herbs, the patient’s insomnia improved significantly.
2.Relationship with the supraoptic nucleus
Waking up with eyes open and sleeping with eyes closed is the normal life experience of general people. In contrast, insomnia patients do not want to close their eyes when lying in bed, or cannot fall asleep with their eyes closed. Tests have proved that the effect of light and dark light on the pineal activity during day and night is related to vision and sympathetic nerves, because the circadian rhythm variation of melatonin secretion is also lost when the animal’s eyeball is removed or the sympathetic nerves innervating the pineal gland are cut.
Therefore, the supraoptic nucleus is considered to be the central circadian rhythm controlling melatonin secretion. The vast majority of people sleep with their eyes closed, and they do not fall asleep with their eyes open. This means that sleep is related to sympathetic nerves, and when sympathetic nerves are excited, a person cannot fall asleep. Then, any disease that causes sympathetic excitement can cause insomnia. The most common disease is hyperthyroidism.
Because of excessive secretion of thyroid hormone, the whole body metabolism is accelerated, sympathetic excitement, increased heart rate, increased sweating, protruding eyes, irritability, easy to have verbal arguments with others, reduced sleep or insomnia, or “fighting” and “quarreling” in dreams, and so on. In this case, we must treat “hyperthyroidism” in order to cure insomnia. Of course, there are many other diseases that cause sympathetic excitation, such as nephritis, renal insufficiency, pheochromocytoma, cervical spondylosis, soft tissue inflammation of the neck, etc.
3. Relationship with cervical sympathetic nerve
Many insomnia patients toss and turn in bed and can not sleep, always feel that the discomfort in the neck and neck affects sleep. In fact, the neck tissue is indeed related to sleep. From the above analysis, we already know that the pineal gland is related to sleep, and the pineal cells are evolved from nerve cells. There are three segments of cervical ganglia distributed in the neck, namely the superior cervical sympathetic ganglion, the middle cervical sympathetic ganglion, and the inferior cervical sympathetic ganglion.
The postganglionic fibers of the superior cervical sympathetic ganglion form synaptic connections with the pineal cells and regulate the activity of the cells of the pineal gland through the release of norepinephrine, i.e. melatonin secretion. Therefore, by adjusting the supra-cervical sympathetic ganglion through stimulation, sleep activity can be adjusted. According to the author’s more than ten years of clinical research, neck diseases are the most common cause of insomnia. The common cervical diseases include: cervical spondylosis, including atlantoaxial subluxation and subluxation, cervical disc protrusion, hypertrophy of the ligamentum flavum, straightening of the cervical curvature or lordosis, cervical osteophytes; inflammatory lesions of the neck muscles, inflammation of the posterior pharyngeal wall, etc. Therefore, in clinical practice, the author uses a variety of methods to treat neck diseases as a way to achieve the purpose of curing insomnia.
4.The relationship with the frontal lobe of the brain
Some people think that the frontal lobe of the brain has a certain relationship with the sleep-wake system of people. And the main function of the frontal lobe is related to people’s thoughts, thinking, emotions, personality, intelligence, memory, etc. Therefore, when people have something in their hearts that cannot be resolved, insomnia often occurs. By inference, any disease that stimulates the frontal lobe of the brain can also cause insomnia. For example, frontal lobe infarction, frontal lobe tumor, etc. There is one type of disease that is closer to the frontal lobe, so these diseases often cause insomnia or poor sleep quality. This type of disease is paranasal sinusitis. As you may know, the paranasal sinuses consist of four parts: maxillary sinus, butterfly sinus, sieve sinus, and frontal sinus, which are connected and can easily cause paranasal sinusitis when you have a cold.
The paranasal sinuses are in close proximity to the brain, and the location of the paranasal sinuses is often referred to as the “danger triangle”, because an infection in this area, if not handled properly or out of control, can lead to secondary brain infection, causing encephalitis or brain abscess. The actual situation is that there are very few cases of encephalitis caused by lesions in the “danger triangle”, while headaches, insomnia, memory loss, dreaming, dizziness, anxiety, depression, etc., are common secondary to paranasal sinusitis. Currently, such patients are often referred to psychiatry, neurology, sleep centers, and otolaryngology for treatment. The treatment by psychiatrists and neurologists is generally psychological counseling, application of antipsychotic drugs, and patients are often made to tremble in their limbs and be unresponsive by the side effects of antidepressants.
The general treatment by doctors in sleep centers is sedation and physical therapy. ENT doctors apply surgical or conservative anti-inflammatory treatment according to the condition to make the condition better or cure. However, ENT treatment is not a complete cure, and many patients will relapse again six months to a year after surgery. Because paranasal sinusitis is particularly close to exopathic factors, physical factors can cause patients to constantly exopathize and gain the disease again. Therefore, the fundamental way out of this problem is to improve physical quality, improve immunity and combine prevention and treatment. The author applies traditional Chinese medicine and treats patients according to their physical factors, which can often solve these problems.
In short, insomnia is a symptom and a disease, when some diseases cause insomnia, insomnia is the symptom of this disease, called secondary insomnia, when the disease that causes insomnia can not be found, this insomnia is primary insomnia. Everything has a cause and a consequence, insomnia is the same, it is best to find the cause of insomnia, then there will be a way to treat insomnia.