Insomnia is the most common type of sleep disorder in clinical practice. Among adults, as many as 10%-15% meet the diagnostic criteria, and the course of the disease is often chronic, and about 50% of the patients have a course of disease that can last for more than 10 years, which seriously damages the physical health of patients, affects the quality of life of patients, and even endangers public safety, causing serious harm to individuals and society.
1. The overall situation of insomnia among adults in mainland China
Insomnia in adults refers to sleep disorders in the adult population characterized by frequent and persistent difficulty falling asleep and/or difficulty maintaining sleep and resulting in unsatisfactory sleep quality. Epidemiological studies have found that 57% of Chinese adults have insomnia symptoms, women have 1.4 times the risk of insomnia, and people over 45 years old have 1.7 times the risk of insomnia, 70%-80% of patients with mental disorders have insomnia symptoms, and 50% of insomnia patients have one or more mental disorders. The main risk factors for insomnia in adults are age, gender, genetics, etc., among which age is the most important, and the prevalence of insomnia increases with age.
2. What are the clinical symptoms of insomnia?
1. Difficulty falling asleep: the sleep latency ≥ 30 minutes.
2. Difficulty in maintaining sleep: too many or too long awakenings, such as more than 2 awakenings for ≥ 5 minutes in the whole night; Wake up time ≥ 40 minutes throughout the night; Awakening time accounts for more than 10% of sleep time.
3. Early awakening: The sleep awakening time is more than 30 minutes earlier than the normal time, and even wakes up 1-2 hours earlier than usual, and the total sleep time is less than 6 hours.
4. Superficial sleep: deep sleep in stages III and IV of sleep in non-rapid eye movement (NREM) PERIODS, less than 10% of total sleep time. The proportion of NREM decreases, the depth of sleep is insufficient, the quality of sleep decreases, and sleep is shallow and dreamy.
5. Daytime symptoms: feeling dizzy, lack of energy, drowsiness, fatigue, etc. the next day.
3. What are the symptoms that can be diagnosed as insomnia?
The diagnosis of insomnia in adults currently follows the diagnostic criteria of the International Classification of Sleep Disorders, 3rd Edition (ICSD-3).
1. Symptom criteria for sleep difficulties (meeting one or more of the following symptoms) :(1) Difficulty falling asleep; (2) difficulty in maintaining sleep; (3) waking up earlier than the expected time to get up; (4) refusing to go to bed at an appropriate time; (5) Difficulty falling asleep without caregiver intervention.
2. Daytime symptom criteria (meeting one or more of the following symptoms related to sleep difficulty symptoms:(1) fatigue or malaise; (2) decreased attention, concentration or memory; (3) impairment of social, family, occupational or academic functions; (4) emotional instability or irritability; (5) daytime drowsiness; (6) behavioral problems (such as hyperactivity, impulsivity, or aggression); (7) decreased motivation, energy or work initiative; (8) Prone to mistakes or accidents; (9) Very concerned or dissatisfied with the quality of their sleep.
3. Frequency standard: ≥ 3 times a week.
4. Criteria for the course of the disease: Sleep difficulties and related daytime symptoms lasted for ≥ 3 months. Adult insomnia can be diagnosed if the above 4 criteria are met at the same time. Diagnostic criteria for short-term insomnia in adults are similar to those for chronic insomnia, but the duration of the illness < 3 months and there is no requirement for frequency.
Exclusion Criteria: Insomnia caused by non-inappropriate sleep opportunities (e.g., adequate sleep time) or environment (e.g., dark, quiet, safe, comfortable environment). Sleep difficulties and associated daytime symptoms cannot be better explained by other sleep disorders.
4. Do I need to seek medical attention for insomnia?
First of all, it is necessary to determine whether it is occasional insomnia or long-term persistent insomnia, and you can compare it with the diagnostic criteria for adult insomnia. The sleep center of the general hospital and the TCM cardiology department of the TCM hospital are suitable for insomnia patients. Clinicians conduct necessary neurological tests, electrophysiological tests, and physical and chemical examinations to complete the diagnosis and give corresponding treatment based on the patient's symptoms.
Insomnia can be treated, don't treat insomnia as an incurable disease. Build confidence and use reasonable and effective methods to cure insomnia.
5. Do insomnia patients have to take medication for treatment?
Insomnia may be primary or secondary to a medical condition. Insomnia with a clear cause, such as coffee drinking, exertion, and environmental changes, can usually be cured after treatment of the cause such as improving the biological rhythm. Symptomatic treatment of insomnia with underlying diseases will also improve sleep quality, such as sleep apnea, sleep quality will be restored after non-invasive breathing therapy and psychological intervention. Not all people with insomnia need medication.
6. What psychotherapy methods can help treat insomnia?
Psychotherapy enhances patients' confidence in self-control sleep by changing the patient's adverse cognitive and behavioral factors, and helps the patient to form a regular sleep-wake cycle and good daytime activities. Sleep hygiene education, cognitive behavioral therapy, sleep restriction, stimulus control, relaxation therapy, ambivalent intention therapy, multimodal therapy, music therapy, and hypnotherapy all have certain curative effects on insomnia. Among them, cognitive behavioral therapy is currently the most widely used psychotherapy, which is suitable for patients with poor efficacy of insomnia drugs.
Author: Li Han
Source: Shenyang Health Service Center
Editor: Chen Yameng
Proofreading: Chen Zeming
Preliminary review: Tong Xia
Review: Xu Jiang