Insomnia

Common symptoms are difficulty falling asleep, decreased sleep quality and sleep time, decreased memory and concentration, etc.

Cause

Insomnia can be divided into two categories: primary and secondary according to the etiology.

1. Primary insomnia

Usually, there is no clear cause, or the symptoms of insomnia remain after excluding the cause of insomnia, which mainly include psychophysiological insomnia, idiopathic insomnia and subjective insomnia. The diagnosis of primary insomnia lacks specific indicators and is mainly a diagnosis of exclusion. When the cause of insomnia is eliminated or cured, it can be considered as primary insomnia when the symptoms of insomnia remain. Psychophysiological insomnia has been found clinically and its etiology can be traced to the effect of a certain or long-term event on the functional stability of the limbic system of the patient. The imbalance of the stability of limbic system function eventually leads to the disorder of brain sleep function and the occurrence of insomnia.

2. Secondary insomnia

Including insomnia caused by physical diseases, mental disorders, drug abuse, etc., as well as insomnia related to sleep-disordered breathing and sleep movement disorders. Insomnia often occurs at the same time as other diseases. Sometimes it is difficult to determine the causal relationship between these diseases and insomnia. Therefore, in recent years, the concept of comorbid insomnia has been proposed to describe those insomnia accompanied by other diseases.

Clinical manifestations

The clinical manifestations of patients with insomnia mainly include the following:

1. Disorders in the sleep process

Difficulty falling asleep decreased sleep quality and reduced sleep time.

2. Daytime cognitive dysfunction

Decreased memory function, decreased attention function, and decreased planning function may lead to daytime sleepiness, decreased work ability, and daytime sleepiness when you stop working.

3. Disorders of autonomic nerves in and around the limbic system

The cardiovascular system is manifested by chest tightness, palpitations, unstable blood pressure, and peripheral vasoconstriction and expansion disorders; the digestive system is manifested by constipation or diarrhea, and stomach fullness; the motor system is manifested by the neck and shoulder muscle tension, headache and low back pain. The ability to control emotions is reduced, and it is easy to get angry or unhappy; men are prone to impotence, and women often have symptoms such as decreased sexual function.

4. Other system symptoms

Prone to short-term weight loss, reduced immune function and endocrine dysfunction.

Diagnosis

The "Guidelines for the Diagnosis and Treatment of Insomnia in Adults in China" formulate the diagnostic criteria for insomnia in Chinese adults: ①Insomnia manifests difficulty falling asleep, falling asleep more than 30 minutes; ②Sleep quality declines in sleep quality, sleep maintenance disorders, awakenings throughout the night ≥ 2 times, early Wake-up and sleep quality decline; ③Total sleep time Total sleep time decreases, usually less than 6 hours.

On the basis of the above symptoms, it is accompanied by daytime dysfunction. Sleep-related daytime functional impairments include: ① fatigue or general malaise; ② loss of attention, attention maintenance or memory; ③ decline in learning, work and/or social skills; ④ mood swings or irritability; ⑤ day thinking Sleep; ⑥ Loss of interest and energy; ⑦ Increased tendency to make mistakes during work or driving; ⑧ Tension, headache, dizziness, or other physical symptoms related to lack of sleep; ⑨ Excessive attention to sleep.

Insomnia is classified according to the course of the disease: ①Acute insomnia, course of disease <1 month; ②Subacute insomnia, course of disease ≥1 month, <6 months; ③Chronic insomnia, course of disease ≥6 months.

The standard process and clinical path for diagnosing insomnia are as follows:

1. Medical history collection

Clinicians should carefully ask about the medical history, including specific sleep conditions, medication history, and possible substance dependence, and perform physical examination and mental and psychological status assessment. The specific content of the sleep status data acquisition includes the manifestations of insomnia, the regularity of work and rest, sleep-related symptoms, and the impact of insomnia on daytime functions. Medical history data can be collected through multiple methods such as self-rating scale tools, family sleep records, symptom screening forms, mental screening tests, and family member statements. The recommended medical history collection process (1 ~ 7 are necessary evaluation items, 8 is the recommended evaluation item) is as follows:

(1) Through a systematic review, it is clear whether there are diseases such as the nervous system, cardiovascular system, respiratory system, digestive system and endocrine system, as well as other types of physical diseases, such as skin itching and chronic pain;

(2) Determine whether the patient has mood disorders, anxiety disorders, memory disorders, and other mental disorders through questioning;

(3) Review the history of drug or substance use, especially the history of abuse of antidepressants, central stimulant drugs, analgesics, sedatives, theophylline drugs, steroids, alcohol and other psychoactive substances;

(4) Review the overall sleep status in the past 2 to 4 weeks, including the latency to fall asleep (the time from going to bed to falling asleep), the number of awakenings during sleep, duration, and total sleep time. It should be noted that the average estimated value should be used when inquiring the above parameters. It is not advisable to use the sleep status and experience of a single night as the diagnosis basis; it is recommended to use a body movement sleep monitor for a 7-day sleep assessment;

(5) For sleep quality assessment, you can use Pittsburgh Sleep Quality Index (PSQJ) questionnaire and other scale tools. It is recommended to use a body movement sleep monitor for 7-day sleep assessment, and a finger pulse oximetry monitor to monitor night blood oxygen;

(6) Evaluate daytime function through consultation or with the help of scale tools, and exclude other diseases that damage daytime function;

(7) It is carried out for patients with sleepiness during the day, combined with a consultation to screen for sleep-disordered breathing and other sleep disorders;

(8) Before the first system assessment, the patient and family members should assist in completing a 2-week sleep diary, recording the daily bedtime, estimating sleep latency, recording the number of night awakenings and the time of each awakening, and recording the time from going to bed to waking up Estimate the actual sleep time based on the morning awakening time, calculate the sleep efficiency (ie actual sleep time/bed time × 100%), record the nighttime abnormal symptoms (abnormal breathing, behavior, exercise, etc.), daytime energy and The extent to which social functions are affected, and the lunch break. Day-time medication and self-experience.

Reference：

Find the right source, cleverly "spring fire". "VIP", 2012

Zhou Yaling. Chinese and Western medicine treatment of insomnia. "Chongqing Medicine", 2009

Huang Lili, Tang Xiangdong. Sleep quality and BMI of patients with insomnia. "The 4th China Sleep Medicine Forum"

Huang Lili, Lei Fei, Du Lina, Tang Xiangdong. Sleep apnea in patients with insomnia. "The Ninth National Academic Conference of the Chinese Medical Association Psychiatry Branch"

Sun Ning, Xu Yanyan, Li Min. Cognitive-behavioral treatment of insomnia. "Health Vision: Medical Volume", 2013

失眠

常见病症是入睡困难、睡眠质量下降和睡眠时间减少，记忆力、注意力下降等。