How to solve the insomnia problem of 300 million Chinese people? The 7 experts from The North, Shanghai Guangrong said so

How long have you not slept well?

In recent years, problems such as difficulty falling asleep, poor sleep quality, and lack of sleep have become the heart diseases of more and more Chinese people, and the data shows that almost 300 million people on the mainland currently have a bad night's sleep.

According to the newly released "2022 Chinese National Healthy Sleep White Paper", 44% of young people aged 19-25 stay up late to midnight, and 42% of the elderly sleep for more than half an hour, with an insomnia rate of 21%. Young adults aged 19-35 are the age group with a high incidence of sleep problems, and poor sleep has gradually become a common pain point for all ages.

Image source: 2022 Chinese National Healthy Sleep White Paper

It is important to know that long-term lack of sleep can cause or increase the risk of cardiovascular and cerebrovascular diseases, depression, diabetes and obesity, impairing cognition, memory, metabolism and the immune system. Sleep disorders can not only cause and aggravate a variety of chronic diseases, but are themselves a chronic disease that deserves attention and is very damaging.

What exactly causes sleep disturbances? What are the current industry solutions? What are the advantages and disadvantages of each? What are the evolution trends of the industry in the future? What do front-line medical experts feel and judge? In response to these problems, on the occasion of the 22nd "World Sleep Day" (March 21), Arterial Network had a detailed discussion with 7 well-known experts from Guangrong, Beijing.

They are:

● Zhang Jihui (Researcher of Guangdong Provincial People's Hospital, Deputy Director of The Department of Sleep Medicine of Guangdong Mental Health Center)

● Zhan Shuqin (Chief Physician, Sleep Specialist, Xuanwu Hospital, Capital Medical University)

● Lu Zheng (Chief Physician, Second-level Professor, Doctoral Student/Postdoctoral Supervisor, Department of Psychiatry, Tongji Hospital, Tongji University)

● Tang Xiangdong (First-class expert physician of Sleep Medicine Center, West China Hospital, Sichuan University, director of Sleep Medicine and Neurobiological Detection Center)

● Le Weidong (Deputy Director of the Academic Committee of Sichuan Provincial People's Hospital, Director of the Institute of Neurology, Vice President of the School of Medicine of the University of Electronic Sciences)

● Jia Fujun (Director, Institute of Mental Health, Guangdong Provincial People's Hospital)

● Huang Zhili (Chairman of China Sleep Research Association, Professor of Fudan University)

Zhang Jihui:

Clinical trials of digital therapies need to be strengthened

Zhang Jihui, researcher of Guangdong Provincial People's Hospital and deputy director of the Department of Sleep Medicine of Guangdong Mental Health Center

Professor Zhang Jihui, a researcher at Guangdong Provincial People's Hospital, told Arterial Network that sleep medicine is booming in the context of sleep disorders becoming a problem for many Chinese people. As an emerging interdisciplinary discipline, sleep medicine is not only the intersection of different medical disciplines, but also the intersection of medicine and engineering, psychology and big data.

With the development of sleep medicine, researchers have gradually deepened their understanding of sleep regulation in the field of basic research, and the development of diagnostic and therapeutic methods for different sleep diseases has also made progress.

Professor Zhang believes that at present, it is mainly from the subjective feelings of patients, as well as some indicators that measure the severity of insomnia or cause insomnia diseases. For example, you can go to the number table of insomnia seriously, or ask the patient about sleep efficiency, that is, how much percent of the average time spent lying in bed is really asleep, or subjectively think whether they have slept well.

In the long run, the improvement of patients' mood, the recovery of energy, and the decline of fatigue are some dimensions that need attention. In this process, cognitive behavioral therapy is being understood and paid attention to by more and more people.

But at the same time, since the outbreak of the epidemic, digital therapy represented by cognitive behavioral therapy has been too hot in the industry, and many companies and products have rushed up, making the track very crowded, especially the homogenization is too obvious. Therefore, Professor Zhang suggested that companies should do a good job of differentiation.

How? From the perspective of industry evolution, at first cognitive behavioral therapy was mainly online, mostly text or audio. At present, there are also cases of adding animation, or combining different modules of text and audio, and there are cases on the market that have done relatively well.

In addition, some companies are also trying to use chatbots to improve the status of patients and increase interactivity, which is the embodiment of differentiation. Of course, the underlying logic of digital therapy is the same, and there is not much difference between the companies.

It should be noted that most digital therapies face the question of whether doctors can approve of it.

For example, doctors will not have any concerns when prescribing drugs, because the compliant drugs that can be listed have done phase III clinical trials, and the safety, efficacy, and side effects of the drugs have been verified, and most drugs have clear data.

So for digital behavioral therapy, if you want to give doctors confidence to use, you need to do clinical trials to prove the safety and efficacy of the product, and which patients will be more effective, give such data.

The other is to improve convenience, that is, the software can bring users a good sense of experience, so that patients can use it more simply. After all, clinicians will encounter a variety of patients, some of them are older, the level of education is not high, the more concise the interface and the simpler the operation, the more acceptable they are.

Then there's the increase in patient compliance, which is a problem for the vast majority of behavioral digital therapies, such as increasing interactions to keep patients interested and willing to use them for a long time.

Professor Zhang finally reminded that the more urgent work to be done by the industry at present is to classify the clinical manifestations of insomnia into subtypes to guide accurate prevention and treatment, such as subtypes to guide doctors to choose corresponding treatment measures, and to develop more new treatment options.

Zhan Shuqin:

Internet medicine for the development of sleep medicine

This presents important opportunities

Director of Sleep Specialist, Xuanwu Hospital, Capital Medical University, Chief Physician Zhan Shuqin

In the view of Zhan Shuqin, chief physician of the Department of Neurology of Xuanwu Hospital of Capital Medical University, the development of the Internet has a great impact on the entire medical field and has also brought many opportunities to disciplines including sleep medicine. For example, doctors can serve more patients across geographical restrictions, and patients can maintain communication with doctors at any time.

In addition, the Internet medical related platform can conduct online disease assessment for insomnia patients and other groups, so that patients do not have to go to the scene, saving time and cost.

What is more significant is that the Internet can alleviate the imbalance of medical resources to a certain extent. Because almost all doctors in hospitals can provide services to their patients on the Internet medical platform.

Taking the Sleep Center of Xuanwu Hospital of Capital Medical University where Director Zhan is located as an example, it is open to patients across the country through the Internet hospital platform, so that patients everywhere can easily find Director Zhan's team online and enjoy high-quality medical resources.

Internet medicine can also help doctors build disciplines. For example, the daily offline reception time is not enough, and the doctor and the patient may not talk deeply enough. Through the Internet medical platform, doctors can chat with patients at any time, which helps to understand the patient's situation in depth.

For groups with sleep disorders, strengthening doctor-patient interaction through the Internet medical platform can also enhance patient compliance. For example, in the Internet hospital, patients will actively communicate with Director Zhan through the center for treatment and follow-up. From a practical point of view, patient participation is high.

According to Director Zhan's observation, when the well-known expert team in various fields communicates with patients online in real time, answers questions for patients in a timely manner, improves patient compliance, and ultimately improves the efficacy of diagnosis and treatment, and generates high trust.

On the Internet platform, doctors can also provide some disease-related knowledge, the diagnosis and treatment process that patients need to understand, and inform patients of the latest correct diagnosis and treatment norms, so as to avoid patients being misled by the false information provided by some criminals, resulting in patients being deceived and damaging property.

Medical service is a relatively high and cumbersome work on the knowledge requirements, doctors need to receive a large number of patients every day, can not meet the desire to fully communicate with patients, through the Internet platform, the routine of medical services encountered in the problems to sort out and standardize and write into popular science articles or make a video on the platform for popular science publicity, improve their overall work efficiency. For doctors, with the help of the platform's technical services and operational support, only medical services or medical knowledge need to be provided to bring patients more continuous and high-quality services.

In addition, the platform can also monitor the actual efficacy. This is because online can regularly evaluate the scale and obtain patient feedback, so as to continuously record the patient's condition and changes, and when encountering a situation of poor efficacy, you can also communicate directly with the doctor immediately to get suggestions for improvement.

Finally, through The Internet medical treatment, doctors can also accumulate a lot of clinical big data to help scientific research, so as to achieve a win-win situation for doctors, patients and platforms.

Lu Zheng:

The field of prevention and treatment of sleep disorders is urgently needed

More new ideas, new technologies and new therapies

Lu Zheng, chief physician, second-level professor, doctoral student/postdoctoral supervisor of the Department of Psychiatry, Tongji Hospital affiliated to Tongji University

Under the general trend of more and more people having sleep disorders, there are still many misunderstandings in the public's understanding of insomnia. In response to this, Lu Zheng, a second-level professor and director of the teaching and research department of Tongji University, told arterial network that the prevention and treatment of sleep disorders needs to pay attention to three aspects.

First, it is necessary to have high-quality science popularization, publicize and popularize professional knowledge to the public, find the cause of insomnia, so as to correct the public's wrong cognition and standardize the public's sleep hygiene behavior. For severe insomnia and stubborn refractory sleep disorders, scientific assessment should be done and better interventions should be proposed.

The second is to find the cause of insomnia. Specifically, the factors affecting sleep can be understood and explored from three dimensions: biological, psychological and social. In particular, some negative emotions, stress, or physical disorders can cause insomnia.

The third is to choose the appropriate intervention method. Psychosocial, behavioral, cognitive, and chemical, physical, and rehabilitation interventions can be carried out comprehensively, which is also a strategy emphasized in domestic and foreign guidelines.

Director Lu said that the Chinese Medical Association, the Chinese Medical Doctor Association, the Chinese Sleep Research Association and other national, provincial and municipal professional institutions are actively promoting the development of sleep medicine, which has brought good opportunities to the industry. For example, many hospitals are preparing to open special clinics for sleep disorders, and even plan to establish a sleep medicine department (center).

There are still many problems with the development of sleep medicine. For example, the number of sleep clinics is still relatively small, most of which are concentrated in major cities such as Beijing, Shanghai, and Guangzhou. The number of talents, the intensity of training and the number of participating institutions need to be improved, so it is necessary to carry out active social publicity and guidance at important time nodes such as World Sleep Day, especially to develop the leadership of medical institutions.

In addition, the current industry's research on sleep medicine is not good enough, and there are few institutions that do standardization in China, which is also the dilemma faced by the industry.

Talent cultivation is essential for the development of sleep medicine. In this regard, Professor Lu believes that we must start from medical institutions, especially to strengthen the work of the affiliated hospitals of universities in the cultivation of talents, and to expand and deepen from the aspects of medical education, research and prevention and rehabilitation.

In the current treatment field of insomnia solutions, Director Lu said that he is optimistic about some new treatments and means. For example, in addition to drug and psychological interventions, the tachymological system with magnetic field physical interference technology as the core is a relatively new and practical system, which is a very good complement to the traditional solution of drug and psychological intervention.

First, the most important treatment for insomnia in the clinic is still drugs, but drugs are far from meeting the needs they should have. The tachym sleep system makes up for this defect very well, which is a non-drug, non-invasive intervention, with relatively small side effects and high patient compliance.

Second, from the perspective of research data, the fast sleep system has the blessing of artificial intelligence and remote diagnosis and treatment, and the overall efficiency is relatively high and the convenience is strong.

Third, it has the characteristics of individualization and precision. That is, through the background, you can understand the situation of patients using the snooze system, give some targeted guidance, and also have data for monitoring. From the perspective of treatment guidelines, on the basis of comprehensive treatment principles, individualized principles, etc., the snooze system is an important supplement.

However, it should still be noted that there are still many pain points in the clinical evaluation, diagnosis and treatment of current sleep medicine.

For example, in the case of assessment-based interventions, many medical institutions and clinics have many shortcomings from the perspective of implementing diagnostic guidelines. Although there are now "Guidelines for the Prevention and Treatment of Insomnia in China", there are deficiencies in the interpretation of the guidelines and the promotion and application of the clinic.

Regarding the future development of sleep medicine, Professor Lu put forward three expectations:

First, it is hoped that there will be a relatively standardized clinical path and a new version of the guidelines, and can be continuously updated in the future, so that practitioners (mainly practitioners of psychosocial psychology) have a comprehensive scientific understanding and clinical application of the development of sleep medicine.

The second is to target different groups of people, such as ordinary people, patients with mental disorders, children, women and the elderly, etc., which can be targeted assessment systems and diagnosis and treatment norms.

Third, in terms of production, education and research, we hope to have more and closer alliances. For example, the research and development institutions of universities, the patient population (database) of hospitals and the support of enterprises can be comprehensively discussed, cooperated and exchanged in this chain.

Tang Xiangdong:

The success rate of CBTI treatment has reached 70 to 80%,

The industry needs to continue to explore

Tang Xiangdong, a first-class expert physician of the Sleep Medicine Center of West China Hospital of Sichuan University and the director of the Sleep Medicine and Neurobiological Testing Center

In terms of new technologies and new therapies for sleep disorders, Tang Xiangdong, a first-level expert physician at the Sleep Medicine Center of West China Hospital of Sichuan University and director of the Sleep Medicine and Neurobiological Testing Center, has made many observations, and he said that CBTI treatment is gradually popularizing.

According to surveys of various populations around the world, the long-term effective rate of CBTI is about two years or more, and the success rate of treatment is between 70 and 80%. But the shortcoming of CBTI is that it requires face-to-face communication, and patients have to go to the hospital once a week. Secondly, doctors are also limited, and the overall efficiency of offline diagnosis and treatment is not high.

At present, the emergence of digital CBTI, coupled with the popularity of WeChat, almost all people under the age of 70 can easily obtain it by downloading mobile phone software. Therefore, Professor Tang said that digital behavioral therapy has become one of the most suitable treatment methods for sleep disorders and should be actively explored.

Take the fast sleep CBTI management system as an example, which is very convenient and can provide patients with a wealth of functions and content. In terms of efficiency, it takes about 15 minutes to basically complete the treatment of one patient, and one doctor can serve 15 new patients every morning.

Of course, any single treatment method has limitations in medicine, so it should be judged according to the specific situation of the patient. For example, for different patients, how to choose a more accurate and targeted program requires careful consideration.

Especially when it comes to online consultation, efforts should be made to identify potential, severe depression patients. For example, for patients with severe depression, most of the effects of drug treatment are relatively good, and there are even radiotherapy options. If for this part of the patient, only the CBTI is used to solve the sleep problem, and the serious emotional disorder behind the patient is not excavated, then the interests of the patient may be damaged.

In addition, how to let the vast group of sleep disorders understand the existing treatment methods, how to expand the publicity effect, so that more people can benefit, this is also a breakthrough direction.

Le Weidong:

The development of brain science in the treatment of sleep disorders

Significant

Le Weidong, deputy director of the Academic Committee of Sichuan Provincial People's Hospital, director of the Institute of Neurology, and vice president of the School of Medicine of the University of Electronic Sciences

Professor Le Weidong, deputy director of the Academic Committee of Sichuan Provincial People's Hospital, director of the Institute of Neurology, and vice president of the School of Medicine of the University of Electronic Science, said that in the field of brain science, some new technologies for insomnia are emerging, such as brain stimulation and magnetic therapy. Behind this, thanks to the research progress of brain science.

Previously, people only knew that there were changes in brain electricity during sleep, but now it is found that this is regulated by the sleep center. These studies are beneficial for better targeted therapies and for the regulation of the sleep center in the future. In addition, non-drug methods such as physical, chemical, optical, and brain stem cells are also helpful for the regulation of sleep.

Professor Le introduced that the study of improving sleep disorders through sleep regulation is one of the important topics of brain science. In this regard, the combination of neurobiology, neuropharmacology, psychology, pathology, physiology and neurology has brought broad prospects for the treatment of sleep disorders.

In the application of new technologies, Professor Le said that good products should have a wider range of use scenarios. For example, the rapid sleep pulse magnetic therapy system developed by pulse magnetic targeting technology has a relatively high technical content and a good innovation, which can be used at home or in hospitals, and has a wide range of applications.

In addition, the snooze pulse magnetic therapy system can change brain activity through pulse magnetic targeting technology, not only improve sleep, but also may also regulate some functions of the brain, the therapeutic effect is more durable, and the side effects are relatively light. Professor Le hopes to follow up with this instrument to observe long-term efficacy.

In the face of more and more new products and new technologies on the market, Professor Le believes that judging whether a product is good or bad, from the doctor's point of view, the focus is on the treatment effect, but not on the short-term effect, but on the long-term effect. Because for the treatment of sleep disorders, the drug is certainly the fastest to see the effect, but long-term use has side effects on the brain, and some drugs are also addictive. Therefore, for a new patient, the doctor will first encourage the patient to use non-drug treatment, and follow up and analyze the scale and EEG data to grasp the treatment effect.

Jia Fujun:

Diagnosis and treatment of sleep disorders also requires graded diagnosis and treatment

Jia Fujun, director of the Institute of Mental Health of Guangdong Provincial People's Hospital

Jia Fujun, director of the Mental Health Research Institute of Guangdong Provincial People's Hospital, told Arterial Network that the diagnosis and treatment of sleep disorders also needs graded diagnosis and treatment.

This is because the top three hospitals have good multidisciplinary medical resources and also have a high level of medical treatment, but the resources of the top three hospitals are always limited relative to the needs of society. Due to the excessive number of patients, it is difficult for patients to receive personalized treatment and intervention in tertiary hospitals.

You know, everyone's psychological state is different, so even if it is the same insomnia symptoms, each person's performance is different, so it is necessary to personalize the intervention methods and measures.

Director Jia said that under the hierarchical diagnosis and treatment of sleep, the top three hospitals should mainly look at difficult diseases and propose a good treatment plan for patients. For ordinary mild diseases, the general clinic can solve it, and it can also implement the treatment plan given by the top three hospitals. In this way, a reasonable division of labor is formed, so that the overall medical efficiency is improved.

Not only that, compared with the queue of the top three hospitals, patients can get some relatively high-quality services when they go to specialized outpatient clinics. For example, personalized services can be obtained at the Sleep Lifestyle Medical Center, where doctors can analyze the physiological and psychological information of patients' sleep feedback through wearable devices and their personal characteristics, so as to give corresponding treatment plans and improve continuous tracking services, so that the efficacy will also be improved.

In general, graded diagnosis and treatment can be viewed from two dimensions, one is the degree of difficulty, and the other is the level of service.

It should be noted that the causes of sleep disorders are complex, involving biological, psychological, sociological and other factors, so psychologists in psychopsychiatry should attach great importance to the patient's other causes. For example, if a child has a sleep disorder, he may be caused by tonsil problems, or some diseases in the department of otolaryngology, which requires the doctor to participate in the diagnosis and treatment with other doctors.

In the new clinical progress of sleep disorders, Director Jia said that the current research methods are constantly updated. Biologically, the cognition of sleep has undergone a gradually deepening cognitive process from organs to tissues to cells, molecules, and genes.

In addition, wearable devices, brain-like research, artificial intelligence, and big data research have also greatly improved the understanding of sleep. With the further development of these technologies, people's understanding of sleep disorders will become higher and higher, and some new treatment methods will continue to emerge and become more and more abundant.

Huang Zhili:

Sleep science education helps the "Healthy China" strategy

Huang Zhili, chairman of the Chinese Sleep Research Association and professor at Fudan University

Sleep is a highly conservative behavior, and 1/3 of a precious life is spent in sleep. Huang Zhili, chairman of the Chinese Sleep Research Association, distinguished professor of Fudan University and doctoral supervisor, said that good sleep can restore physical strength, accelerate the discharge of metabolic waste in the brain, enhance immunity, promote growth and development, is an important guarantee for the storage and consolidation of learning and memory, and the agility of thinking, and is also the best "skin care product" to protect the face.

Today, the process of industrialization is rapid, the work pressure is increasing, the population aging is aggravated, especially the many bad lifestyles derived from the information age, and more and more people have sleep problems. Long-term sleep disorders bring serious physical and mental diseases, such as diabetes, glucose intolerance, hypertension, reduced anti-infection ability, tumors and other chronic physical diseases, but also increase the risk of anxiety, depression and other mental illnesses.

Interestingly, on the issue of sleep, regional differences are very obvious, and the length of sleep varies from occupation to occupation.

Globally, 1/3 of people have insomnia, and the mainland is no exception. The latest survey in the mainland shows that nearly 75% of the people surveyed have sleep troubles within one year, the proportion of people who sleep less than 7 hours has increased by 25%, the number of people with sleep disorders remains high, and the trend of rejuvenation is obvious. Mobile phones have become sleep killers, and nearly 70% of people who sleep late are related to playing mobile phones.

The mainland is vast and has obvious regional differences, tibetans sleep the longest, and Sichuan people sleep most comfortably. The phenomenon of napping is common in the four provinces of Shanxi, Chongqing, Anhui and Guangdong. Age differences: primary and secondary school students do not have time to sleep, young people work hard and often stay up late, and the elderly have time but cannot sleep. Gender differences: women usually wake up early, sleep time is shorter than men, men snore more, and women are more likely to wake up. Nature of work and sleep: People's police are the most sleep-deprived, and frontline epidemic prevention personnel sleep less. Teachers and doctors have the worst quality of sleep; although the takeaway brother is hard, he sleeps soundly when he lies down.

There are nearly 100 diseases of sleep disorders, with the highest incidence of insomnia, followed by sleep breathing syndrome, restless leg syndrome, abnormal sleep behavior during rapid eye movement, teeth grinding and so on.

Taking insomnia treatment as an example, the first thing is to establish a healthy sleep lifestyle through popular science publicity and education, and appropriately combine other non-drug treatment methods, such as cognitive behavioral therapy, exercise therapy, light therapy, aromatherapy, music, current electricity, pulse magnetism, etc.

Medication is generally effective and safe, including chemicals and traditional Chinese medicines. However, patients with long-term medication will also have side effects and drug resistance. Many patients believe that the drug is three points toxic, and they are very afraid of the drug, which affects the effect of insomnia treatment. However, if the insomnia is serious, which seriously affects the work efficiency, quality of life and mood of the next day, it is recommended to carry out the necessary drug treatment. In short, insomnia is not terrible, first of all, to overcome willfulness, establish a healthy sleep lifestyle, through comprehensive measures and methods, will definitely find good sleep.

Therefore, the importance of popular science is reflected, so that people with sleep disorders have the correct cognition, in order to choose the right way and method.

The work of popularizing science disseminates the advanced achievements of human civilization, leads the way forward with the advanced, replaces ignorance and backwardness with the progress of civilization, suppresses falsehood, evil and ugliness with truth, goodness and beauty, and helps the people improve their scientific and cultural quality. Since its launch in 2021, the Yousleep Science Popularization Action has paid attention to, cared for and cared for the general public, continuously innovated publicity models, and disseminated advanced sleep science research results, aiming to enhance the public's understanding of sleep science; close to the needs of the masses, publicize to the people the effective way to achieve high-quality sleep, and let the people benefit, benefit and be satisfied.

Through sleep science, the national awareness of healthy sleep is being significantly improved, and the requirements for good sleep are getting higher and higher. On March 17 this year, the Chinese Sleep Research Association released the Chinese theme of "Good Sleep and Healthy Peers" for the 2022 World Sleep Day, and also looked forward to more experts, scholars, news media and friends from the business community to join in this theme publicity. Healthy sleep first of all to the people to put the scientific sleep lifestyle into action, a series of popular science activities will enhance the public's understanding of sleep science knowledge and healthy sleep, improve the quality of healthy sleep science of the mainland people, and enhance the happiness of the people's healthy life. High-level sleep science to help the healthy China strategy.

Healthy China has been elevated to the height of national strategy, without the health of the whole people, there is no comprehensive well-off, the key to a healthy China is to firmly grasp the humanistic nature of medicine and the correct direction of prevention, and push medicine from "curing the disease" to "treating the disease".

Among the elements of human health, "good sleep" is the cornerstone, and everyone is the first person responsible for their own good sleep. Sleep health is the key to a healthy China.

*Cover image source: 123rf