Inspired by "self-controlled analgesia", the "self-controlled sleep" and the multimodal sleep formed on this basis can not only make insomnia patients sleep when they want to sleep, but also do not cause side effects such as excessive sedation and respiratory depression. For patients with stubborn insomnia, this is a new treatment concept and means.
Sleep is a spontaneous and reversible resting state that occurs periodically in humans, manifested by a decrease in the body's responsiveness to external stimuli and a temporary interruption of consciousness. Studies on sleep are telling us more and more that sleep has an irreplaceable role in human health.
Insomnia is not only painful but also dangerous
Insomnia is difficulty falling asleep in an environment suitable for sleep, frequent awakenings at night or waking up too early in the morning, and there must be social function damage such as fatigue, lack of concentration, low work efficiency and irritability caused by poor sleep quality and insufficient sleep time.
It should be noted that occasional insomnia cannot be diagnosed as insomnia. In addition, insomnia is not considered if the sleep time is insufficient, but the daytime brain function is not affected after waking up. If you have insomnia 2 to 3 times a week for more than 1 month and are accompanied by daytime social dysfunction, you need to be vigilant. If the above conditions persist for 3 months and do not resolve, the diagnosis of insomnia is certainly established.
Inefficiency and errors are problems that tend to occur after insomnia. Cognitive impairment due to insomnia can bring different degrees of harm depending on the occupation. The most dangerous are insomniacs in high-risk occupations, where the probability of triggering catastrophic accidents increases dramatically. Data show that the crash of the space shuttle Challenger and the accident of the Chernobyl nuclear reactor are related to the lack of sleep of the staff.
Traditional therapies are less than satisfactory
At present, the treatment of insomnia mainly includes drug therapy, physical therapy, alternative therapy and cognitive behavioral therapy.
Physical therapy mainly includes repeated transcranial magnetic stimulation, electroconvulsive therapy, transcranial direct current therapy, etc. There are many types of physiotherapy, and the small side effects are its outstanding advantages, but the efficacy varies greatly from individual to individual. Repeated transcranial magnetic stimulation therapy is more studied and popular, but it has not yet reached a consensus among experts worldwide and is therefore not included in the guideline recommendations. Alternative therapies include acupuncture, qigong, and yoga.
Sleep drugs are mainly benzodiazepines represented by diazepam. In recent years, some hospitals have also used antidepressants and antipsychotics for the treatment of insomnia. Drug therapy is by far the most common treatment for insomnia. However, long-term medication or improper medication can easily lead to drug dependence and addiction. In addition, studies have shown that sleeping pills have the risk of falling, dementia and tumors. Therefore, drug treatment of insomnia should be controlled as much as possible for no more than two weeks, and a maximum of four weeks.
Cognitive behavioral therapy is by far the only recommended insomnia treatment in the field of sleep worldwide. Its core content is to treat insomnia by correcting the relationship between the person and the bed, in short, the bed is only used for sleep and sexual activity, and all other activities should not be carried out in bed. Cognitive behavioural therapy can be performed face-to-face between doctors and patients, or over the phone or the Internet. Cognitive behavioral therapy is generally considered effective in 50% of insomnia patients.
Inspired by "self-controlled analgesia"
The idea of a self-controlled sleep method dates back to the mid-1990s. At that time, there was a very important technological progress in the field of pain medicine, that is, the invention and application of patient self-control analgesia technology.
This is a kind of analgesic effect that uses the principle of computer control to achieve "self-control, time-sharing, and immediate results" of patients. We used this revolutionary technique to effectively control postoperative pain in cardiac surgeons, but at the same time found that preoperative fear and insomnia caused by surgery were also a thorny problem, so we considered relieving preoperative tension through patient self-control and anti-anxiety. Although this design was not realized at the time because of the lack of drugs that could induce natural sleep, it inspired us to try to let patients control their sleep on their own.
In recent years, with the widespread use of natural sleep-inducing drugs and the improvement of patient self-control drug delivery technology, "patient self-control sleep" has finally been realized. After more than 6 years of practice and exploration, we have put forward the new concepts of "patient self-controlled sleep" and "multi-mode sleep", which is the original contribution of China's anesthesiology community to international sleep medicine.
"Patient self-controlled sleep" is with the help of self-controlled drug delivery devices and drugs, when insomnia patients want to sleep, they can inject the appropriate amount of drugs into the body by pressing the organs, thereby inducing a method of natural sleep or physiological sleep, giving people the experience of "sleeping when you want to sleep".
The first significant advantage of "patient-controlled sleep" is that the concentration of the drug is controlled within a safe range, which allows the patient to fall asleep without causing side effects such as excessive sedation and respiratory depression. The second advantage is that "patient-controlled sleep" can induce natural sleep, allowing the patient's brain to restore an appropriate proportion of light, deep and fast-moving sleep, and restore the sleep rhythm of about 5 cycles per night. Fast eye movement sleep is also the dreaming period, which together with deep sleep constitutes the core sleep, and the core sleep is the key to sleep quality.
At the beginning of "patient self-control sleep", the main effect is reflected in the correction of abnormal sleep rhythms, after a period of repeated sleep structure regulation, we found that the patient's anxiety and depression and other comorbidities gradually disappeared, and the brain nerve structure damaged by insomnia was also repaired.
Multimodal sleep can improve the effect
About 50% of insomnia patients rely on self-controlled sleep technology alone to cure insomnia. In this case, multimodal sleep comes into being.
The so-called multimodal sleep is to use multidisciplinary and various means to solve the main contradictions existing at different stages of insomnia patients. Treatment involves anesthesiology, pain, psychiatry, otolaryngology, neurology and other departments, in addition to "patient self-controlled sleep", there are also repeated transcranial magnetic stimulation, cognitive behavioral therapy and so on. Clinical practice shows that multimodal sleep with "patient self-controlled sleep" as the main line can greatly improve the cure rate of patients with refractory insomnia.
Multimodal sleep is primarily indicated for drug-dependent chronic refractory insomnia. Insomnia patients are mainly manifested in sleep rhythm disorders in the early stage of the disease, which is a functional change, and if it cannot be corrected in time, it will cause damage to brain nerve cells. This is also an important pathological basis for chronic insomnia that is difficult to cure. "Patient self-controlled sleep" as the main line of multimodal sleep is to repeatedly correct the disturbed sleep rhythm for a long time, and gradually achieve the purpose of repairing brain cells and curing insomnia. Therefore, the biggest difference between this treatment and the past is the emphasis on treating insomnia from the cause.
Of course, "self-controlled sleep" is not yet perfect. For example, the need to open intravenous access for a long time is not only inconvenient for patients, but also carries the risk of infection. In the future, we envision solving this problem with programmable closed intrathecal administration while drastically reducing drug dosage. In addition, the working parameters of the current "patient self-controlled sleep" device still need to be manually titrated and adjusted, and it is expected that artificial intelligence technology can replace it in the future.
In order to help the high-quality development of the health industry, the "Medical Vision" column will focus on advanced concepts and excellent practices in various fields of medicine, build a high-end doctor think tank, capture innovative highlights, condense development ideas, and improve governance capabilities.
Planner: Fang Tong
Author: An Jianxiong, Vice President of Aviation General Hospital of China Medical University
Editor: Zheng Yingpan, Wang Jianying, Hu Bin