Insomnia is not terrible, scientific sleep aids can help you overcome it

Author: Zhang Yan, deputy chief physician, Peking University Third Hospital

Reviewer: Zhao Haiyan, deputy chief physician, Peking University Third Hospital

Insomnia, a common sleep disorder, has attracted more and more attention. It not only affects our daily life, but also may have long-term effects on our health. If you suffer from insomnia for a long time, it is recommended to seek professional help. Professional doctors can provide targeted treatment plans based on your specific situation and help you sleep scientifically.

1. If you suffer from insomnia, you should seek medical attention immediately

Insomnia is a common clinical problem. Insomnia can be manifested as taking more than 30 minutes to fall asleep under appropriate sleep opportunities and sleeping environments, awakening more than twice throughout the night, waking up earlier than usual, and feeling dissatisfied with sleep time and/or sleep quality after waking up in the morning. It can also be accompanied by daytime fatigue, low mood or irritability, physical discomfort, and cognitive impairment. It is a subjective experience.

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From the perspective of the course of the disease, insomnia is not only characterized by persistence, but also has certain fluctuations and may be relieved naturally. For patients whose insomnia is caused by certain physical diseases, such as patients with prostatic hyperplasia who often suffer from insomnia due to frequent urination at night, or patients who have difficulty falling asleep due to itchy skin at night, they need to seek medical treatment for related diseases to improve insomnia. Elderly people often suffer from physical diseases such as hypertension, diabetes, hyperlipidemia, coronary heart disease, stroke, asthma and obstructive sleep apnea. They also often suffer from common mental disorders such as anxiety and depression. At this time, insomnia may be a clinical symptom of a physical disease or a mental disorder, or it may be an independent disease. When a patient seeks medical treatment, the attending doctor should not only analyze the patient's underlying disease, but also analyze whether insomnia is related to the acute stress event faced by the patient, or the use of drugs/substances that cause insomnia, or the patient's poor sleep habits, or changes in the sleeping environment.

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According to the course of the disease, insomnia less than 3 months is short-term insomnia, while insomnia ≥ 3 months is chronic insomnia (long-term insomnia). Long-term insomnia will seriously affect daily work, life and memory, and will also increase the risk of various health problems. Therefore, it is recommended to seek medical attention in time after insomnia occurs, especially to prevent short-term insomnia from becoming chronic.

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2. Insomnia can be cured without medicine

Insomnia does not necessarily require medication. There are many other treatments, including psychotherapy, physical therapy, and traditional Chinese medicine.

1. Psychotherapy

Psychological treatment mainly includes sleep hygiene education and cognitive behavioral therapy for insomnia (CBT-I).

(1) Sleep hygiene education: ① Avoid drinking coffee, strong tea or smoking 4 to 6 hours before bedtime; ② Do not drink alcohol before bedtime; ③ Exercise regularly every day and avoid strenuous exercise 3 to 4 hours before bedtime; ④ Do not overeat before bedtime; ⑤ Avoid doing things that are easy to excite people 1 hour before bedtime; ⑥ Keep the bedroom environment quiet and comfortable, with appropriate light and temperature; ⑦ Ensure a fixed sleep time. Patients should carry out other treatments on the basis of establishing good sleep hygiene habits. For special populations with drug contraindications or higher risks of medication, non-drug treatment is of great significance.

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(2) CBT-I: It is the "gold standard" for non-drug treatment of insomnia and the first-line intervention measure recommended by relevant guidelines. It is also the most representative non-drug treatment method supported by evidence-based medicine to date. Commonly used treatments are as follows.

A. Sleep restriction therapy: Increase the ability to fall asleep by shortening the awake time in bed to improve sleep efficiency. Specific content: ① Reduce the awake time in bed to make the bed time consistent with the actual sleep time. When the sleep efficiency is maintained above 85% for at least 1 week, the bed time can be increased by 15 to 20 minutes; ② When the sleep efficiency is lower than 80%, reduce the bed time by 15 to 20 minutes; ③ When the sleep efficiency is between 80% and 85%, keep the bed time unchanged; ④ Take a regular nap of no more than 30 minutes, avoid daytime naps, and maintain a regular wake-up time.

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B. Stimulus control therapy: ① Go to bed when you feel sleepy; ② If you do not fall asleep after lying in bed for 20 minutes, you should get up and leave the bedroom, and return to the bedroom to sleep when you feel sleepy; ③ Do not do activities unrelated to sleep in bed, such as eating, watching mobile phones or TV, reading, listening to the radio, and thinking about complex problems; ④ Maintain a regular waking time. This therapy can re-establish a benign conditioned reflex between waking up and sleeping, and is recommended as a "standard" non-drug therapy for difficulty falling asleep and maintaining sleep.

C. Relaxation therapy: It is suitable for insomnia patients who feel that they "cannot relax" and have various physical discomforts. There are three main forms, including progressive muscle relaxation/body scanning training to reduce skeletal muscle and body tension, abdominal breathing training to induce a slower and deeper abdominal breathing pattern similar to that when sleep occurs, and imagination relaxation training to adjust the body and mind to relax by self-imagination or recalling a comfortable environment or state. Relaxation therapy aims to reduce the insomniac's autonomous awakening, muscle tension and thoughts that interfere with sleep, thereby improving insomnia.

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2. Physical therapy

Physical therapy includes repetitive transcranial magnetic stimulation, transcranial microcurrent stimulation, transcranial direct current stimulation, electrostatic therapy, EEG biofeedback, music therapy, light therapy, aromatherapy and exercise therapy.

3. Traditional Chinese Medicine Treatment

The non-drug treatments for insomnia in traditional Chinese medicine include acupuncture, massage, moxibustion, cupping, acupoint application, electroacupuncture, ear acupuncture, acupoint injection and acupoint embedding, etc. Through the above non-drug treatments, insomniacs may be able to improve their condition without taking medicine, which is worth trying.

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