Insomnia refers to sleep difficulty, is the most common sleep disorder, is also one of the most common clinical complaints, namely, unable to sleep, sleep instability and wake up cannot recover the spirit. The causes of insomnia are varied and can be caused by mental and physical diseases, including mental disorders, respiratory disorders, alcohol consumption, drug use, myoclonic or restless leg syndrome in sleep, and so on. It can be manifested as difficulty in falling asleep, frequent awakenings and early morning awakenings. Difficulty in falling asleep or starting to lose sleep are often associated with mood disorders such as anxiety, fear or depression. Early awakening is a common phenomenon in older people, but it can sometimes be a symptom of depression, and it is important to note that the perception of anxiety, self-blame and self-punishment is often exacerbated in the morning.
Recently insomnia, often caused by all kinds of anxiety at that time, such as husband and wife quarrel, human relations, work problems, sexual conflict of guilt, the attention to their health and worries, etc. If there are no such psychological and emotional problems, the cause of somatic disease should be considered. Simple symptomatic measures that do not work are often caused by severe mood disorders, especially depression. The national institutes of health proposed in 1983 a temporary classification of insomnia into three types: transient, short-term and long-term. Identifying the classification of insomnia is useful in determining appropriate treatment measures.
Transient insomnia is caused by sudden situational tension, such as hospitalization or surgery, and jet travel, which usually lasts only a few days.
Short-term insomnia is also associated with tension in the environment, but can last up to three weeks. Common causes include broken relationships, job stress, the disruption of circadian rhythms caused by the time difference between a test, a night shift and a long-distance travel by plane. Withdrawal of certain stimulants, caffeine, alcohol and smoking can also be caused.
Long-term insomnia, persists for more than three weeks, 1/3-1/2 patients is caused by some kind of potential mental disorder, especially heavy depression, and long-term alcohol and drug dependence is the second cause of adult patients with chronic insomnia. Other causes related to pain, neuropathic pain and various types of headache, sleep apnea, nocturnal myoclonic seizure and restless leg syndrome. Patients with chronic pain often get more pain during the night when they sleep, because the external environment is less stimulating and more focused on the inside of the body. Patients with angina and irregular heart rates are often afraid of sleep, and they worry about the onset of nocturnal disease and isolation. It is very necessary to understand the cause of insomnia and take corresponding psychotherapy.
The treatment of insomnia depends on its underlying etiology and the duration of its chief complaint, and the formulation of a drug and non-drug treatment regimen that meets the needs of each patient. The treatment of insomnia, for many patients, must be attention and emphasis on psychological treatment, through assure their explanation and that shows that sleep deprivation is due to normal anxiety or curable body diseases caused by, no serious consequences. Providing the patient with an opportunity to relieve anxiety often reduces pain and helps restore normal sleep. Older adults who have normal sleep patterns also need to explain and guarantee, and encourage them to do more physical activity during the day to guide them to relax. Drinking moderate amounts of warm milk before bed can sometimes help some patients sleep. Medication should be classified according to the condition and course of insomnia:
Most patients with transient insomnia, once the cause of insomnia, symptoms can disappear, in this case may need medication, or to give patients a small rapid excretion of sleeping pills May 1 ~ 2 is enough.
In the short term, patients with insomnia should relieve their tension factors and improve their individual adaptability through psychotherapy. Give the patient the advice and training of mental relaxation, and guide him to arrange a reasonable sleep system; Avoiding naps during the day, drinking caffeinated drinks and going for a walk before bed may be beneficial. The minimum effective dose should be given at least 3 weeks for sleeping pills. If you have a good night's sleep, you can reduce your dosage by the following night, or maintain it for another day or two.
The causes of chronic insomnia need to be evaluated by special neurological, psychological and spiritual aspects. If there are mental disorders, appropriate treatment must be given; Drug addicts should be detoxified and rehabilitated; Pain triggers can be used as analgesics; Nocturnal myoclonus can be alleviated by using benzodiazepines similar to clonazepam.
Drug therapy must be in parallel with psychotherapy, regular physical exercise and relaxation, and should be used as a short-term test for drug therapy. Sleeping pills are only take to achieve this purpose and auxiliary means, namely, break the vicious cycle of insomnia, eliminate fear of insomnia, eliminate anxiety, reduce the awakening of more emotional and physical. Fluorine azepam, triazobenzene and temazepam are the most common drugs used to treat insomnia. Quazepam, azepam, diazepam and chloroxyazepam are also effective sleeping pills. Triazobenzene is the most effective way to sleep, which can shorten the latency of sleep. Clonazepam and temazepam are most effective in the prevention of sleep disturbances, because of their long duration. The alertness and dexterity of the hand during the day after the use of the drug is disturbing, as is the case with triazobenzene and temazepam.
Dosage moderation according to introducing, the effect of sedative hypnotics vary with different doses, small amounts to produce sedation, moderate doses can cause approximate physiologic sleep, large doses of anesthesia and anticonvulsive action. It is best to choose the minimum dosage when you can sleep. But do not be afraid of the side effects of the drug to reduce dosage, the dosage must follow the doctor's advice.
The time of continuous take should not be too long, generally not more than two weeks long-term take is easy to produce tolerance and dependence, after stopping the drug insomnia only aggravates. If patients often take some sleeping pills, these drugs can make liver medicine has increased, enzymes produced by the "tolerance", so whether it is a kind of insomnia, continuous use of a sleeping pill. In addition, sleeping pills are mostly detoxification by liver, kidney excretion, if often take sleeping pills, should pay attention to regularly check liver, kidney function.