Interviewee: Zhang Tao, director of the Department of Sleep Psychology, Army Characteristic Medical Center, Army Medical University
Global Times health client reporter Ren Linxian
"I have been very anxious and finally survived by taking sleeping pills, and sometimes I can't wait to pour (eat) a bottle of sleeping pills into it!" Yu Minhong, chairman of New Oriental, recently mentioned in a conversation that when New Oriental initially adjusted and transformed its organizational structure, he couldn't sleep at all for several years, and in the last 10 years, he took almost 3,000 sleeping pills, and at most he had to take 4 tablets a night to fall asleep. Can sleeping pills be taken for a long time? Will there be side effects?
At present, more than 300 million people in the mainland have sleep disorders, and many people become irritable and weak due to insomnia, which seriously affects normal life and work, and finally has to choose drug intervention. However, sleeping pills have quite a few side effects, especially as they can be addictive. Other studies have found that long-term use may lead to memory loss and increase the risk of Alzheimer's disease. The US Food and Drug Administration (FDA) even requires dexzopiclone, zaleplon, and zolpidem, three commonly used sleeping pills, to add a "black box warning" to indicate that it may cause disability and death, and ensure that patients and doctors are vigilant and safe to use.
In this regard, Zhang Tao, director of the Department of Sleep Psychology of the Army Characteristic Medical Center of the Army Medical University, told the Global Times Health Client reporter that everyone should rationally view the drug treatment of insomnia. Long-term clinical practice has proved that short-term use of sedative-hypnotic drugs can help induce sleep and relieve symptoms, and the health benefits of patients far outweigh the risks of insomnia and side effects of sleeping pills. "Theoretically, taking sleeping pills for more than 10 years is indeed a bit long. Long-term and large-scale use of sleeping pills is unreasonable, not only easy to lead to liver and kidney burden, drug resistance, addiction problems, but also may produce drug dependence, including psychological dependence on drugs, further induce depression. ”
1. Who is prone to insomnia?
Director Zhang Tao said that insomnia will not only lead to dizziness and headache, sallow skin, hair loss, and difficulty concentrating, but also increase the risk of "three highs", peptic ulcer, cerebrovascular disease, damage the immune system, and induce rheumatic diseases, ankylosing spondylitis, cancer, etc.
In recent years, especially after the new crown epidemic, the number of insomnia patients has been increasing. Insomnia is prone to everyone from teenagers to people over 65 years old. Insomnia in the elderly is mostly related to chronic diseases, psychological anxiety, etc.; Insomnia in young adults is mostly related to emotional tension and anxiety brought about by work and life; Insomnia in adolescents is associated with stress, anxiety, poor sleep hygiene habits, and cognitive perceptions such as going to bed early and playing with mobile phones before bed. It should be reminded that insomnia in one group of people may be related to family inheritance.
2. When to consider sleeping pills?
Insomnia is a subjective experience characterized by dissatisfaction with sleep duration and quality despite appropriate sleep opportunities (timing) and sleep environment. Common specific insomnia problems include difficulty falling asleep, waking up early, and difficulty maintaining sleep (waking up more than 3 times at night).
Symptoms of acute or transient insomnia disorder do not require medication: 30%~50% of people will have this type of insomnia in their lifetime, that is, occasional insomnia, lasting no more than 3 months.
Chronic insomnia requires pharmacological intervention: insomnia occurs more than 3 times a week for more than 3 months, and necessary interventions, including medication, are required to consult a doctor for advice.
3. What is the safe time and dosage of sleeping pills?
Director Zhang Tao said that after the patient uses sleeping pills continuously for 3~4 weeks under the guidance of a doctor, if the sleep problem is not improved, he should return to the doctor for drug adjustment, or further rule out whether there are emotions, special diseases (hyperthyroidism, "three highs") and other problems, and find the cause of insomnia. In addition, there are alternate medication (change the drug about once a week or two), intermittent medication (three or four times a week) and other forms of medication, and how long to use it must strictly follow the follow-up recommendations of specialists. Specific dosage: Most tranquilizers can be 1 tablet a day, no need to add. It is worth noting that after taking sleeping pills, you can wake up again in the middle of the night, and do not add sleeping pills, which is not beneficial to relieve insomnia symptoms.
4. How to view the adverse reactions of sleeping pills?
Director Zhang Tao said that any drug has adverse reactions, and the adverse reactions of sleeping pills include addiction and dependence. Patients with mental health problems and substance use disorders are more likely to develop drug dependence, which can lead to addiction in cases of drug abuse such as irregular and high-dose medication. However, as long as it is used reasonably, regularly and scientifically according to the doctor's recommendations, the chance of adverse reactions will be greatly reduced. According to relevant studies, the memory loss and decline caused by insomnia are much higher than those of sleeping pills, so insomnia symptoms should be actively intervened.
5. What are the common sleeping pills?
At present, the drugs for the simple treatment of insomnia are mainly tranquilizers, which can quickly hypnotize falling asleep, including two categories: one is benzodiazepine sedative sleeping pills, such as estellan, lorazepam, etc.; The other is non-benzodiazepine sedative sleeping pills, including dexzopiclone, zaleplon, zolpidem, etc. Possible side effects include: hangover reaction (dizziness, drowsiness, drowsiness and other symptoms may occur the next morning), short-term amnesia, etc.
Clinically, there are many patients who actually have insomnia caused by anxiety, depression, etc., and antidepressants can be used, which can not only relieve insomnia symptoms, but also improve mood, and some can also improve the complicated symptoms caused by emotional problems (such as overeating, indigestion, etc.). However, these drugs have a long half-life and a relatively high incidence of hangover reactions.
6. Eight precautions for taking sleeping pills:
(1) Sleeping pills with a short half-life are preferred.
(2) Start with the smallest effective dose and take as needed.
(3) For patients with intermittent insomnia, it is best to take medicine at intervals, 3~4 times a week.
(4) Do not add sleeping pills when waking up in the middle of the night.
(5) Do not drink alcohol for hypnosis, and do not take sleeping pills after drinking.
(6) After the symptoms improve, it cannot be stopped suddenly, and the dose should be gradually reduced.
(7) For long-term use of sleeping pills, it is recommended to check the liver and kidney indicators every 3 months, especially the elderly.
(8) Look at sleeping pills correctly and do not have fear or dependence on sleeping pills.
7. There are five ways to improve insomnia:
(1) Maintain regular sleep habits to ensure the quality of sleep between midnight and 4am.
(2) Do meditation and mindfulness exercises before going to bed.
(3) Relax your mind before going to bed, play less with your mobile phone, do not make plans for the next day, etc., and listen to light music, audiobooks, etc.
(4) Relax your body before going to bed, do not do strenuous exercise, do not fall asleep in a hungry state, and do not overeat.
(5) Make up sleep should not disrupt the rhythm, such as staying up late at night, you can get up half an hour late the next day, do not take a nap for more than 1 hour, go to bed early at night, and do not use the daytime to make up a lot of sleep. ▲