Sleep problems, a modern disease
Sleep is so important to health, but the study of it in medicine is an emerging field. In 1953, Dr. Nathaniel Kleitman of the University of Chicago noticed that people occasionally experience rapid eye movement during sleep, so he began to study this phenomenon during sleep. In the first 10 years of sleep medicine, people didn't know much about sleep, all their energy was devoted to research, and patients were not treated. It wasn't until the late 1960s that Dr. Anthany Calles at UCLA established the first Center for Sleep Disorders.
? Sleep medicine in my country is still in its infancy. The Sleep Center of the Air Force General Hospital is one of the earliest hospitals in my country to carry out clinical polysomnography research. Gao He, former vice president of the Air Force General Hospital and director of the sleep center, said that the Air Force General Hospital developed early because of special needs. One is Fighter pilots are highly sensitive to sleep. For example, the U.S. military flies from the mainland to the Balkans. This kind of long-term flight across time zones requires sleep medical intervention for pilots to maintain a good state of alertness. In addition, with the development of the aviation industry, the biorhythm of astronauts will change after they go to space, and research must be carried out. When the first batch of astronauts were training in foreign space centers, the EEG changes in the simulated space environment were analyzed by the Air Force General Hospital.
In addition to these special fields, China's understanding of sleep problems has been in different secondary disciplines for a long time. Gao He said that in the early 1980s, only Xiehe Hospital began to diagnose sleep-disordered breathing. This is a sleep laboratory for a specific disease, and it is not a complete discipline of sleep medicine. in the subject. That is to say, if you want to find out the root cause of your insomnia, you have to register with psychiatry, psychology and behavioral medicine, otolaryngology, head and neck surgery, geriatrics, etc. Inevitably have to look at other. Once sleep disturbance rises to the level of sleep medicine, the problems it involves are related to many internal problems in the human body in addition to sleeping late and getting up early because of looking at mobile phones. For example, anxiety and stress, sleep apnea manifested as snoring symptoms, periodic limb twitching, narcolepsy, and even medical factors such as brain tumors, Parkinson's disease, and thyroid disorders can also cause insomnia.
In the past 10 years, doctors of different specialties have gradually realized the intersectionality of sleep problems, and some large hospitals have established sleep centers across departments. Ye Jingying used to be the chief specialist of the Throat Department of Tongren Hospital, specializing in the diagnosis, treatment and surgery of sleep apnea syndrome. She said that she realized the comprehensiveness of sleep problems very early, but a long-established hospital has its own traditions, so in 2014 she transferred to Tsinghua Changgung Hospital to establish a sleep center, which still focused on her specialty, sleep apnea disorder, However, it covers joint diagnosis and treatment of sleep-related departments such as cardiovascular medicine, respiratory medicine, and endocrinology.
In addition to serving people with special occupations, the Air Force General Hospital established the Department of Sleep Medicine in 2013. Director Gao He is an expert in internal medicine respiratory diseases and critical illnesses. He is also the leader of the expert group of the Air Force General Hospital. The center has worked as a senior research scholar. The sleep research center he leads not only provides diagnosis and treatment, but also trains professional sleep physicians and sleep technicians. Pan Jiyang's professional background is psychiatry. He said that a common symptom of anxiety and depression is insomnia, so in 2003 he went to the Sleep Center of the University of Pennsylvania to study sleep medicine diagnosis and treatment techniques. "Sleep doctors in the United States also have two majors. Doctors of various disciplines take the exam of the American Academy of Sleep Medicine, and after passing the exam, they get a sleep specialist license. Department, etc., and a second professional sleep department." Pan Jiyang said.
Don't worry too much about insomnia, relax first
Sleep is so important to our health and is often said to occupy a third of our lives, yet we know so little about it. Gao He said that sleep can be called a clinical specialty. First of all, it has an independent sleep disease spectrum, which determines the scope of clinical diagnosis and treatment, that is, sleep-related diseases during the occurrence of sleep. It cannot be seen during the day, but only during sleep There are nearly a hundred kinds of these diseases, which are divided into several categories. For example, difficulty falling asleep, not waking up, sleep-disordered breathing, parasomnia, like leaving the bed in a deep sleep state, turning around and going back; sleep movement disease; rhythm problems, like going to bed late and being forced to wake up early And the formation of delayed sleep phase syndrome. There are also sleep problems caused by some diseases that need to be screened.
The threshold for ordinary people to read and understand this disease catalog is very high, but there are also methods of self-awareness. Gao He said that the length of sleep does not have to be 8 hours or 9 hours as it is rumored. "The shortest sleep time that a person can tolerate is 5 to 6 hours. There are also some people who are long sleepers and need to sleep for 8 to 9 hours. The crowds of these two extremes are relatively small, and most people are in the middle. , that is, sleep for 7.5 hours to 8 hours. For the elderly, sleep loss is not necessarily a problem. As people age, the sleep structure will change. To judge the quality of sleep, in addition to the length of sleep, In fact, there is another very important factor, which is the functional state when you are awake. No matter how many hours you sleep, if you are in a good state during the day, it means that you have enough sleep. Sleeping is the same as eating. Everyone’s appetite is different. Same, as long as nutrition is guaranteed.
Occasional insomnia and staying up late are also normal, so don’t worry too much about it, but if you have persistent poor sleep, you have to suspect that there is something wrong with your sleep. Symptoms of poor sleep include, Lying for more than half an hour and still not falling asleep, waking up frequently in the middle of the night, waking up very early every day and never being able to fall asleep again, or a combination of the three. Gao He said that this state occurs more than three days a week and lasts for three to six months. For a month or even longer, you may have to pay attention.
A common but often overlooked sleep problem is sleep apnea. Gao He said that people often criticize the phenomenon of dozing off during meetings, thinking that they do not pay attention to work, but in fact it may be caused by sleep apnea. "Sleepy during meetings during the day, it must be that he has sleep deprivation at night. The most common sleep deprivation problem in adults is sleep apnea, especially those who are overweight, have a short neck or slightly defective facial structure, have smoking and drinking habits, and chronic pharynx. Those with internal problems are all high-risk groups. Although he sleeps for 8 hours at night, his sleep structure and quality will be disturbed when he stops breathing for a while. During the day, there will be sleep pressure in his body, and he will fall asleep instantly during a meeting. .”
?In addition to physical causes of insomnia, Dr. Peter Howrey wrote in "Say Goodbye to Insomnia" that according to the national statistics of the United States, at least half of insomnia is caused by psychological causes, such as depression, anxiety, and marital stress Or work stress. Clinicians in China have different backgrounds in hospitals, and the understanding and treatment of patients with insomnia are also different from those in the United States. Therefore, there are no authoritative statistics in this regard. However, in the interviews, doctors all mentioned that insomnia is caused by psychological reasons. Insomnia is indeed common.
There is an anxiety-induced insomnia, or even anxiety sleep itself. Almost every doctor interviewed mentioned that they often encounter patients who insist on exaggerating their sleep problems. Fortunately, the polysomnography data of the sleep center can convince patients that they are not sleeping as little as they think, or Since I found out that I have insomnia symptoms, sleep has become a big thing. I have tried many ways to control it, but the more I control it, the more counterproductive it is.
Li Zhanjiang, vice president of Beijing Anding Hospital Affiliated to Capital Medical University, is the vice chairman of the Cognitive Behavior Therapy Professional Committee of the China Mental Health Association. He is good at treating anxiety disorders, depression disorders, insomnia, eating disorders and other mental disorders. He said that it may not be scientific to spread some small ways to help sleep in daily life, such as counting sheep if you can't fall asleep. In fact, the more you pay attention to when you can fall asleep, the more you concentrate on counting sheep, the more excited you will be. When the brain puts in more effort, it causes cortical arousal and emotional arousal. At this time, if you see that you have not fallen asleep, you will feel anxious. Anxiety wakes up the body again, the skin and hearing become sensitive, the surrounding environment feels uncomfortable, or the frequency of going to the bathroom is increased. Going to the bathroom so many times, I can't sleep anymore. "So, we tell patients to accept their sleep state, let nature take its course, think about whatever they think, and not deliberately control themselves in the process, but to relax."
Depression and anxiety involving psychological symptoms are similar to those of sleep. The relationship is bigger. Li Zhanjiang said: "In the early stage of depression, there may be symptoms of insomnia, or it may be that the sleep is relatively light, but in the full period of depression, the patient can sleep well, but wakes up earlier. This is a type of depression. The characteristic is called terminal insomnia.” More than half of the patients with mental disorders treated by Li Zhanjiang have sleep problems. He said that emotional problems often manifest themselves in eating and sleeping. For example, many patients in the Department of Gastroenterology now find that they have emotional problems, and the refractory patients need to make psychological adjustments, and even use some anti-anxiety or depression drugs. The same goes for sleep. Anding Hospital also established a sleep center 5 years ago, and many patients with mental disorders have to go to the sleep clinic.
Another important significance of sleep to mental disorders is that many mental diseases have the possibility of relapse, and one of the important precursors is sleep problems. "When I communicate with patients, I always say that after recovery, we must adhere to a regular life and ensure adequate sleep. These are not empty words, they are really important, which is equivalent to psychological self-care, which can reduce or prevent the disease. relapse."?
No need for sleeping pills
China's sleep medicine has just started. Gao He said that there are nearly a hundred diseases related to sleep problems, and they can be solved skillfully and accurately in one environment. There are still relatively few such sleep centers in China, and the number is far away. Can not satisfy the needs of people to see sleep problems. In several well-known sleep centers in Beijing, all beds for polysomnography need to be queued. For most people who pay attention to their sleep, it is more feasible to master some self-help methods first.
Gao He said that drinking caffeinated beverages such as coffee or tea, smoking, drinking alcohol, and watching mobile phones, iPads, and TV before going to bed can all affect sleep. A research report in the United States shows that the brain cells of insomniacs are in a highly active state and cannot fall asleep. If they take caffeine again, it will make the situation worse. Nicotine is also a stimulant like caffeine, keeping you awake. And if you consume alcohol within two hours before going to bed, it is likely to reduce the quality of sleep. Another doctor emphasized that the blue light spectrum of the electronic screen is the enemy of sleep, it will interfere with the rhythm and affect the stability of sleep. Removing these living habits is the first step in solving sleep problems.
Sometimes anxiety and worry come from little we know, at least when it comes to sleep. You have to relax first, don't try to control it, before sleepiness hits you.
In addition to living habits, insomnia is also related to some behaviors. Gao He said that under normal circumstances, people should go to bed when they are sleepy. In this case, the feeling of sleepiness and the contact between the human body and the bed form a conditioned reflex. As long as you lie on the bed when you are sleepy, the contact between the bed and the human body becomes a stimulus to induce sleep. But some people suffer from insomnia for a period of time due to some reason, and they don’t know how to deal with it. The more they can’t sleep, the more they want to go to bed earlier, and they lie on the bed and can’t fall asleep. Once this kind of physiological insomnia is formed, you would feel sleepy while sitting, but you will not be sleepy when you lie on the bed. It is because you are dealing with insomnia or doing a lot of things that have nothing to do with sleep on the bed for a long time, which destroys the sleep aid of the contact between the human body and the bed. relation.
Summing up these living habits and behaviors, they are actually the three elements of sleep formation. Gao He said that the first element is sleep pressure, which is equivalent to eating when people are hungry. From the time you wake up in the morning, the longer you stay without sleep, the more stressful you will be going to bed, and the faster you will fall asleep. Those living habits that are not conducive to sleep, such as drinking tea at night, looking at mobile phones before going to bed, and some people do not sleep well at night to catch up on sleep during the day, etc., release the sleep pressure before the main sleep period, and cannot fall asleep when lying down. The second element is biological rhythm. People should respect the natural rhythm of sleeping and waking to go to sleep, and maintain a relatively regular work and rest. The human body can play a good role under the regular rhythm. If the time of going to bed and waking up is often irregular, it may be misaligned with your own biological clock and cause insomnia. The third is the physiological awakening caused by behavioral problems. When you are not sleepy, you lie on the bed, which destroys the sleep-aiding conditioned reflex of the human body and the bed. If you cannot sleep, you become anxious and wake up the body.
Compared with other diseases, sleep is special in that not all of them need drug treatment. Gao He said: "The dosage of sleeping pills, the process of taking and stopping, the timing, etc., the problems of the medicine itself and the psychological problems after stopping the medicine are not something that the patient can control by himself, and the doctor must explain it to the patient well. According to the data on the treatment of insomnia in the United States, more than half of the sleep problems are treated by cognitive behavioral therapy instead of drugs." In the international insomnia treatment guidelines, cognitive behavioral therapy is also used as the first-line treatment method, which is a psychological treatment method. A sort of. Li Zhanjiang said that the principle is that people's emotional feelings will be reflected in their behavior. Therefore, some people experience various things or internal diseases in the body, produce negative evaluations and form some emotional experiences, and the body responds accordingly, such as sleep problems. The doctor must change the patient's emotional core by changing the patient's behavior or cognition, so as to achieve the effect of changing the body's feelings.
Social transformation, accelerated pace of life, high pressure and fierce competition will indeed affect people's emotions and psychology. Taking depression as an example, many of the patients Li Zhanjiang treated in the past were caused by biological factors such as family inheritance, but now they are more caused by psychological factors. "Because of the inner conflicts brought about by life, work, and interpersonal relationships, because of the emotional changes caused by the difference between my expectations and reality compared with others, I feel that others are good, but I am not good, and I am more and more self-deprecating and depressed. It is easy to appear." Li Zhanjiang said. Stress management is also often problematic. The increased anxiety level caused by stress is a normal emotion that should be possessed by normal people. "The most classic explanation is the fight-flight response. When a person encounters a threat, he has to face the risk and mobilize the body's resources. The blood pressure will rise, the muscles will tense, and they will have more strength. Anxiety is a kind of thing that promotes people's progress and development. Motivation, but everyone’s ability to withstand pressure is different. Faced with the same pressure, some people’s work improves, while others collapse. This is called psychological toughness or psychological flexibility. It can be exercised and adjusted.” Li Zhanjiang said .
Maybe it's the relaxing professional habits of doctors with mental disorders, maybe it's because insomnia symptoms are not as difficult to treat as imagined, Li Zhanjiang's tone is not serious when talking about the causes and treatments of insomnia. He said that by changing the lifestyle and adjusting the work and rest to form a virtuous circle, sleep problems will be effective within two months. Cognitive-behavioral therapy in the sleep clinic can be performed routinely 6 times. However, if there is a problem with sleep, you must have sleep knowledge and early intervention. The longer the course of the disease, the more difficult it will be.
Sometimes anxiety and worry come from little we know, at least when it comes to sleep. You have to relax first, don't try to control it, before sleepiness hits you.
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