Is insomnia caused by insomnia? Experts: There are four major criteria for diagnosing insomnia

The China Sleep Research Society recently released the "2022 China National Healthy Sleep White Paper". In this "White Paper", experts systematically displayed the current sleep status, sleep cognition, and sleep needs of Chinese people from the dimensions of sleep conditions, work and sleep, sleep trends, and sleep cognition. The survey shows that difficulty falling asleep and lack of sleep have almost become the biggest "stumbling block" to the health of the Chinese people.

The White Paper shows that nearly three-quarters of the respondents have had sleep problems, and difficulty falling asleep is the number one problem faced by most people. From the perspective of different age groups, young people are more likely to be "night owls", and more than 40% of young people aged 19-25 stay up until after midnight before going to bed, making them the well-deserved "champions of staying up late"; while the elderly are the hardest hit group with difficulty falling asleep and frequent insomnia, and most of them need to use drugs to improve their sleep; at the same time, analysis found that 70% of the causes of late sleep are related to mobile phones, which can be called "sleep killers". The White Paper shows that whether it is "old, middle-aged, young", or children and teenagers, poor sleep has become a common pain point for all groups.

So, here comes the question: Is there a clear diagnostic standard for insomnia? Who are the "black hands" behind sleep disorders? There are several common types of sleeping pills at present. How to choose scientifically and rationally? Although sleeping pills are helpful, why are they not recommended for long-term use? The reporter asked Li Xina, deputy director of the Department of Pharmacy of the First Affiliated Hospital of Harbin Medical University, to interpret and answer questions.

Four criteria for diagnosing insomnia

The famous writer Voltaire once described, "God gave us hope and sleep to compensate for all the troubles in the world. But now, good sleep is becoming a luxury!" In this regard, pharmacist Li Xina pointed out that one-third of human life is spent in sleep, and good sleep is a necessary condition and "solid foundation" for health. However, according to the survey data of the World Health Organization, 27% of people in the world have sleep problems. As a common sleep disorder, insomnia not only brings serious negative impacts to daily life and work, reduces the quality of life, but also may lead to serious accidents. Therefore, consultation on insomnia has become a topic often encountered in pharmacist clinics.

Li Xina introduced that according to the "International Classification of Sleep Disorders, 3rd Edition", insomnia can be diagnosed if all the following four criteria are met: difficulty falling asleep, maintaining sleep or awakening early; difficulty sleeping despite ample opportunities and an appropriate sleeping environment; impaired daytime function due to sleep difficulties, including fatigue or discomfort, impaired attention, concentration or memory, social dysfunction, occupational dysfunction or poor academic performance, mood disorders or irritability, daytime sleepiness, decreased enthusiasm, energy or initiative, mistakes or accidents at work or driving, and concern or worry about sleep problems; sleep-wake difficulties that cannot be better explained by other sleep disorders.

The dark hand that kills sleep health

From a clinical perspective, the duration of insomnia is usually divided into short-term insomnia and chronic insomnia. The former is also called adaptive insomnia or acute insomnia, which lasts for a few days or weeks, generally not more than 3 months, and is caused by identifiable reasons such as mental tension before an exam, night pain from herpes zoster, etc. The latter refers to insomnia symptoms that last at least 3 months, and most patients report that insomnia symptoms have been with them for many years. Pharmacist Li explained: In fact, sleep problems are very complicated, sometimes existing independently, and sometimes mixed with multiple problems, like a tangled mess, entangled and confusing.

First, there are physiological or physical reasons. Some people with existing physical diseases, such as tumors, gout, and trigeminal neuralgia, will suffer physical discomfort, which naturally makes normal sleep difficult. Second, stress-induced insomnia accounts for half of the cases. For example, fierce competition in the workplace, tense interpersonal relationships, and unsatisfactory living conditions will all make people "restless". Third, as many as 70-80% of patients with mental disorders suffer from insomnia, and 50% of insomniacs suffer from mental disorders. Fourth, drug inducements, such as certain antibiotics, antivirals, anti-tuberculosis drugs, anticoagulants, lipid-lowering drugs, interferons, etc., will destroy sleep quality.

Age, gender and lifestyle are also important factors that challenge sleep health. Li Xina explained that the first factor is age. Most elderly people have reduced secretion of growth hormone and melatonin, which causes the biological clock to speed up, disrupting the normal rhythm of the human body and inducing sleep disorders. The second factor is gender. Statistics show that women suffer from insomnia 1.41 times more than men of the same age. This is because women's estrogen is easily "driven" by the menstrual cycle, and they are sensitive and have low psychological tolerance, making them more likely to "stay awake all night."

What is particularly serious is that young people, who are regarded as "fireflies", often delay going to bed due to heavy work or personal preferences. Some of them play games, poker or linger in the online world late at night. Such people owe "sleep debts" for a long time, which often induces anxiety and depression, and their physical health will also be in trouble. This wakes up the public. If they want to improve their sleep quality, they must find out the crux of their own problems and correct them as soon as possible, and at the same time develop a good habit of falling asleep regularly. If sleep cannot be improved in the short term, they should consider using drugs to treat insomnia. But which sleeping pill is suitable for you? What are its advantages and disadvantages? You should listen to the opinions of doctors and pharmacists and not make your own decisions.

How to choose the three types of drugs

Li Xina introduced that there are three main types of commonly used anti-insomnia drugs, including benzodiazepine receptor agonists, melatonin receptor agonists and antidepressants with hypnotic effects. Benzodiazepine receptor agonists mainly include two types of drugs, non-benzodiazepines and benzodiazepines. Representative non-benzodiazepine drugs that have been widely used in clinical practice since the 1980s are zolpidem, eszopiclone, zopiclone and zaleplon. The first three drugs are fast-acting and can be used for difficulty falling asleep and sleep maintenance disorders. Zaleplon has a short half-life and is only suitable for difficulty falling asleep. These drugs have low blood concentrations and generally do not cause daytime sleepiness. If you still can't fall asleep 30 minutes after going to bed, wake up at night and can't fall asleep again, and it is more than 5 hours away from the expected time, you can "take it as needed."

Benzodiazepines emerged in the 1960s. These drugs have sedative, hypnotic, antianxiety, muscle relaxant and anticonvulsant pharmacological effects, which help to combat difficulty falling asleep and increase total sleep time. Representative drugs include estazolam (Sulopenia), alprazolam, lorazepam, diazepam (Valium), flurazepam, etc., but their adverse reactions are more obvious, including daytime sleepiness, dizziness, falls, cognitive impairment, etc.; and stopping the drug soon after long-term use may induce withdrawal symptoms and rebound insomnia. If it is necessary to stop using, it is advisable to reduce the dosage or intermittently administer the drug to gradually "step on the brakes."

Although ordinary melatonin has a hypnotic effect, there is insufficient evidence for the treatment of insomnia, and it is usually not used as a routine medication for common adult insomnia. Melatonin receptor agonists such as ramelteon can improve sleep efficiency and increase total sleep time, and are currently approved for the treatment of insomnia. Some antidepressants have a sedative effect and are more effective when insomnia is accompanied by depression and anxiety. Representative drugs include doxepin, amitrylin, trazodone, mirtazapine, venlafaxine, duloxetine, etc. Pharmacist Li introduced that a small dose of doxepin can regulate chronic insomnia in adults and the elderly, and has been used as one of the recommended drugs for sleep maintenance disorders. Drugs such as amitrylin and trazodone are generally used in patients with insomnia accompanied by anxiety and depression. It should be emphasized that antidepressants must be prescribed by a psychiatrist after diagnosis and treatment.

Sleeping pills should not be addictive

Pharmacist Li Xina reminds that for the elderly, pregnant women, breastfeeding women or people with respiratory diseases who are taking multiple medications at the same time, they need to inform the doctor of the above situation before using sleeping pills and prescribe appropriate prescription drugs. For those with short-term insomnia, they should actively find and eliminate possible causes, such as gout causing physical discomfort and sleeplessness; excessive workplace pressure causing mental tension and sleeplessness all night, all of which require symptomatic treatment of the primary disease, timely relieving negative emotions, and relieving them from the source. When patients feel that they can control their sleep, they can consider gradually getting rid of their dependence on sleeping pills.

At the same time, it is very important to develop good sleeping habits in daily life, which is also a prerequisite for cooperating with doctors to overcome insomnia. Pharmacist Li Xina warned that, for example, do not touch stimulants such as coffee and strong tea within 4-6 hours before going to bed, do not overeat or eat fried and greasy food; do not drink alcohol before going to bed at night, especially do not use alcohol to help fall asleep; also pay attention to proper daily exercise, try to avoid strenuous physical exercise at night; at the same time, it is best not to play online games, listen to the radio, watch TV, listen to the radio, etc. after going to bed, and put an end to all activities that are not related to sleep.

In addition, taking hot baths, massaging the soles of the feet, and using medicated pillows instead of ordinary pillows can also relieve insomnia. You may want to give it a try.