Insomnia is a kind of sleep disorder, characterized by frequent and persistent difficulty in falling asleep and/or maintaining sleep, which leads to dissatisfaction with sleep. Insomnia can exist in isolation, or it can coexist with mental disorders, physical diseases or substance abuse. Treatment methods include psychotherapy, lifestyle adjustment and medication.
Insomnia is divided into chronic insomnia, short-term insomnia and other types of insomnia. Chronic insomnia generally refers to the course of disease ≥3 months and the frequency ≥3 times/week.
With the increase of age, the incidence of insomnia increases, and the incidence of women is higher than that of men. Unpleasant life events are an important cause of insomnia. Insomnia can occur alone or in patients with depression or anxiety. Other causes such as physical pain and nervous system diseases are also common.
Insomnia patients mainly show difficulty in falling asleep or maintaining, such as waking up early. The daily life and work of patients are seriously affected.
The purpose of insomnia treatment is to increase effective sleep time, improve sleep quality and improve living and working conditions during the day.
The cause of disease
There are many reasons for insomnia, such as stress, anxiety, irregular sleep, poor sleep environment and so on. In addition, it can also be caused by some mental or organic diseases, such as depression, anxiety and hyperthyroidism.
Disease factors
mental sickness
Common are anxiety, depression, bipolar disorder and so on.
Other health problems
Such as pain, dyspnea and restless leg syndrome.
Related diseases
Anxiety, depression, restless legs syndrome, rapid eye movement sleep disorder
Non-disease factors
pressure
Due to nervousness or fear of certain events, or long-term chronic stress, such as work or study pressure.
Bad sleep habits
For example, lying in bed watching TV, or sleeping disorders.
Sleep environment change
Such as short-term business trip, bed change, noise, too strong ambient light, etc.
symptom
Insomnia is not only an independent syndrome, but also a symptom of many diseases. Every patient has different insomnia symptoms, which may be manifested as difficulty in falling asleep, easy to wake up, early waking up, poor sleep quality and so on.
Symptom classification
trouble falling asleep
Lying in bed for more than an hour is still insomnia.
Maintenance difficulty
It's easy to wake up at night, but it's hard to fall asleep after waking up. Or wake up early in the morning.
Lack of sleep
After waking up, I still feel tired, listless and anxious during the day, and my work or life quality declines.
characteristic symptoms
It is difficult to fall asleep, easy to wake up, wake up early, wake up and fall asleep. Sleepiness during the day, physical decline, accompanied by tension and depression. In severe cases, there are symptoms of autonomic nervous disorder such as increased heart rate, increased body temperature and contraction of peripheral blood vessels.
Concurrent syndrome
Anxious
It may come from the anxiety that lack of sleep at night affects work during the day.
depressed
Insomnia patients are often accompanied by depression. Patients with depression often show insomnia in the early stage.
complication
Endocrine disorder
Insomnia can lead to biological rhythm disorder, which in turn affects endocrine function. Women are also prone to increase the risk of breast cancer.
Decreased immune function
It is prone to various secondary diseases.
to be hospitalized/be admitted to hospital
Insomnia often seriously affects the normal work and life during the day and requires medical treatment. The main treatment methods include psychotherapy and medication.
Indications of drug therapy
If insomnia has seriously affected the normal work and life during the day, please seek medical advice as soon as possible.
Medical department
Department of neurology and psychology
The doctor inquired about the illness.
When do you sleep and wake up? Is it mainly difficult to fall asleep or maintain sleep?
What did you do from night until you fell asleep in bed? How do you feel?
Do you take any exciting substances for a long time?
How is your daily life? Have there been any incidents that have interfered with daily life recently?
Do you snore or gasp when you sleep? (You can ask your partner)
Any other symptoms? (such as decreased interest, poor acceptance, anxiety, etc.). )
Should women also evaluate menstrual cycle, pregnancy or menopause?
Inspection that needs to be carried out
Subjective assessment tool
Sleep diary
Activity and sleep were recorded 24 hours a day for two weeks.
Scale evaluation
Pittsburgh Sleep Quality Index, Sleep Disorder Rating Scale, Epworth Sleepiness Scale, Insomnia Severity Index Scale, etc.
Objective evaluation tool
Polysomnography
It can accurately record the changes of sleep time, awakening times, breathing and heart rate.
Multiple sleep latency test
Assess the degree of daytime arousal and drowsiness tendency.
Physical exercise record examination
Evaluate the sleep-wake rhythm.
diagnostic criteria
Have insomnia symptoms, including difficulty in falling asleep and maintaining sleep; Wake up earlier than expected; Refuse to go to bed at the right time; Without the intervention of parents or caregivers, it is difficult to sleep.
Insomnia affects work and life, including fatigue or discomfort; Decreased attention, concentration or memory; Impaired social, family, professional or academic functions; Emotional instability or irritability; Decrease in motivation, energy or work initiative, etc.
I have suitable sleep conditions and time, and I still have symptoms of insomnia. These sleep difficulties and related daytime symptoms appear at least three times a week for more than three months.
Do not belong to other types of sleep disorders.
differential diagnosis
Insomnia caused by physical illness
Including nervous system diseases, endocrine diseases, cardiovascular diseases, respiratory diseases, digestive system diseases, genitourinary system diseases and musculoskeletal system diseases, are not insomnia.
psychosis
In addition to insomnia symptoms, patients with depression may also have core symptoms such as depression, decreased interest and mental retardation. Patients with bipolar disorder may have symptoms of depression and mania, which makes it difficult to fall asleep; In addition to typical anxiety, fear and worry, anxiety patients are often accompanied by autonomic nervous symptoms such as palpitation and accelerated breathing.
treat cordially
The purpose of insomnia treatment is to increase effective sleep time and/or improve sleep quality; Improve daytime damage related to insomnia; Reduce or prevent short-term insomnia from turning into chronic insomnia; Reduce the risk of physical illness or mental disorder related to insomnia.
Family handling
Overcome bad living and sleeping habits and create a comfortable sleeping environment. Restrict or prohibit daytime naps. Listen to some soft and soothing music to relax before going to bed.
Go to the hospital for treatment
medicine
Benzodiazepines and non-benzodiazepines
Sedation and hypnosis are produced by inhibiting the excitation center. The former includes estazolam, alprazolam and lorazepam. The latter includes zopiclone, zolpidem, etc.
Melatonin receptor agonist
For example, Rametidine is mainly used to treat insomnia with difficulty in falling asleep as the main complaint and insomnia caused by circadian rhythm disorder.
Doping
Include trazodone, mirtazapine and deanxit. Has sedative effect, and is suitable for depression and/or anxiety accompanied by insomnia.
traditional Chinese medicine
Chinese herbal medicines such as Ziziphus Spinosae Semen and Semen Platycladi have certain curative effects on insomnia.
psychotherapy
Sleep cognitive behavioral therapy is the first choice to treat insomnia. Clinical practice has proved that it has a short-term and sustained curative effect, which can help insomnia patients develop good sleep habits and eliminate their worries and fears about insomnia symptoms.
physiatrics
phototherapy
A light box equivalent to 200 times the light intensity in an ordinary room is placed in front of the patient about 1 m, and it is continuously irradiated for 2-3 hours in the morning and evening, so that the biological clock of human sleep awakening is moved forward or delayed. This phototherapy method is mainly suitable for patients with sleep disorders with rhythm disorders, such as sleep phase delay syndrome, sleep disorders caused by shift work and age-related sleep disorders. However, it should be noted that insufficient irradiation intensity or too short irradiation time can not produce curative effect, while too strong irradiation or too long irradiation time is prone to eye fatigue, serious retinal damage, headache, dizziness, irritability and other symptoms.
Repetitive transcranial magnetic stimulation
Specifically, repetitive transcranial magnetic stimulation (rTMS) continuously acts on a certain area of the brain at a fixed frequency and intensity. High frequency (< 1 Hz) is mainly an exciting function, while low frequency (≤ 1Hz) is an inhibiting function. Low-frequency (≤ 1 HZ) repetitive transcranial magnetic stimulation can inhibit the excitability of cerebral cortex, increase the amplitude of slow-wave sleep, deepen sleep depth and enhance memory.
prescribe a diet
Long-term insomniacs should pay attention to the intake of food with the functions of nourishing the heart, calming the nerves and promoting sleep in their daily lives.
Diet regulation
The daily diet should be light and digestible, such as beans, milk, cereals, eggs, fish, melons, spinach, apples and oranges.
Don't eat too much at dinner, don't eat within two hours before going to bed, and don't drink a lot of water, so as not to stimulate the cerebral cortex due to gastrointestinal irritation, or it is difficult to sleep because of increased nocturia.
nurse
Insomnia patients often have no spirit at work and make mistakes at work. Proper physical and mental relaxation can reduce stress and help to establish good sleep habits.
Daily nursing
Develop regular work and rest and sleep habits, and you can go to sleep naturally through conditioned reflex when you go to bed.
Keeping good hygiene habits before going to bed and soaking feet with warm water every day before going to bed can play a hypnotic role.
Avoid overeating at dinner, and it is advisable to eat lightly. Avoid eating 2 hours before going to bed, and don't drink strong tea or coffee before going to bed.
prevent
preventive measure
Correct bad sleep habits and don't watch stimulating TV and books before going to bed.
Keep the sleeping environment quiet, adjust the light in the bedroom as dark as possible, and adjust the temperature of the bedroom to 24-28℃.
Exercise regularly, quit smoking and drinking, etc.