In recent years, the proportion of people with sleep disorders in mainland China has been rising, especially after the new crown epidemic, the number of people who complain of sleep problems in hospitals has skyrocketed. I believe everyone has a similar experience, and neighbors often mention in chats: "My daughter has taken the college entrance examination this year, and she has lost sleep every day in recent months, and it is really distressing to look at the dark circles under her eyes"; "That little cub in my family, he didn't sleep at ten o'clock at night, and finally turned off the lights and lay on the bed, but he played with his hands, his feet, and his touches, but he didn't sleep well"; "Since I was infected with the new coronavirus, I have hardly been able to sleep every day for the past two years"; "I really want to go to a training class to learn how to sleep......
The question is, isn't sleeping something that everyone does every day? Do you still have to learn this?
The answer is yes. Recently, patients often ask me questions like this: "Doctor, will my sleep problems recur after I have been cured of them by you this time?" How long do the results last after treatment with you? ”
As a clinician, to be honest, neither of these questions is easy to answer. For the first question, if the answer is answered directly, it will discourage the patient's compliance and affect the treatment effect. If you answer no, you are obviously deceiving yourself. As for the second question, it is necessary to remind the general public: insomnia, especially intractable insomnia, is not formed in a day or two, and there is no shortcut to treatment. In order to cure insomnia, in addition to scientific treatment methods, it is very important to correctly understand sleep, learn self-discipline and adopt correct behavioral methods to correct it!
In other words: solid insomnia treatment requires: scientific therapy + self-discipline + cognitive-behavioral correction. For the vast majority of people, after the improvement of sleep quality through systematic treatment in hospitals, if there are sleep-unfriendly behaviors in daily life, insomnia recurrence is very likely; On the contrary, if you develop a good routine from the beginning of insomnia treatment and learn to use scientific and effective cognitive behavioral therapy, it is conducive to improving the long-term efficacy.
Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for insomnia recommended by the Chinese Guidelines for the Diagnosis and Treatment of Insomnia Disorders. Its core is to help people identify and change the negative perception and sleep habits of sleep, break the original wrong thinking patterns, rebuild a good sleep rhythm, and then reduce or even stop drug therapy for patients, which is a sustainable and cost-effective non-drug therapy. Studies have shown that the correct use of cognitive behavioral therapy can effectively improve and consolidate the long-term treatment effect of refractory insomnia.
However, most people don't know much about sleep-related cognitive behavioral therapy, so if you want to have a healthy, satisfying sleep, you really need to learn! To use cognitive behavioral methods to treat insomnia, it is first necessary to change the irrational beliefs and unadaptive behaviors about sleep caused by long-term sleep deprivation, that is, from the individual's "cognition" and "behavior" at the same time.
Cognitive therapy
Common sleep-related distress related to sleep perception includes:
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Unrealistic sleep expectations (e.g., I must get at least 8 hours of sleep every day to cope with the next day's study or work).
2. Catastrophic consequences of insomnia (e.g., if I don't sleep well tonight, I may have a breakdown tomorrow and can't do anything).
3. Misattribution/evaluation (e.g., if I performed so badly today, it's because I haven't slept well lately).
The above sleep-related worries can increase anxiety and stress and exacerbate sleep disturbances, and common cognitive correction points include:
1. Keep realistic expectations for sleep and don't rush back to normal.
2. Don't blame insomnia for some impairment of function during the day.
3. Don't put too much emphasis on sleep and don't try to try to fall asleep.
4. Allow yourself to have insomnia, and don't be upset that you don't get a good night's sleep once in a while.
Of course, the above few words are far from enough, after all, most people cannot make a significant change in their thinking in a short period of time. Therefore, cognitive sleep therapy is a step-by-step process that takes an average of 6-8 weeks. By increasing the understanding of sleep and realizing that sleep itself is fluctuating, it is not surprising that healthy people occasionally have insomnia, even if they often have insomnia, as long as it does not obviously affect daily study or work, it can be accepted, etc., in order to fundamentally break the vicious circle of anxiety caused by insomnia, the more anxious the more insomnia.
Behavioral therapy
At present, there are many methods of sleep behavior treatment, and you can easily get a detailed introduction to hundreds of behavior therapies through Internet searches, such as sleep deprivation, stimulus control, mind therapy, relaxation therapy, exercise therapy, drinking milk, foot soaking, etc. Some therapies are very simple and suitable for all ages, but they are not very effective (such as music therapy, which is a disaster for people who need a quiet environment to fall asleep); Some therapies are effective but difficult to implement and even dangerous (eg, hypoxic apnea therapy). Each behavioral therapy has its own rational explanation, but it may not be suitable for everyone, or every therapy may only work for certain populations. In this massive number of behavioral therapies, the author recommends several relatively reliable methods for you through screening and comparison.
- Sleep restriction therapy
People with sleep disorders tend to have a similar tendency to sleep in the belief that increasing the amount of time spent in bed is effective in increasing the chances of falling asleep, which in fact can lead to scattered sleep and low-quality sleep. Sleep restriction therapy is to measure the average time to fall asleep each day through a week's sleep diary, judge sleep efficiency according to this statistical time, and then carry out sleep restriction. The therapy requires a week of sleep recording, and the average sleep duration in one week is the total time spent in bed each day for the second week. Sleep restriction is based on a 1-week cycle, and when the 1-week is over, sleep efficiency needs to be calculated.
Calculation of sleep efficiency: Assuming that the total time spent asleep in 1 week is recorded as T1 and the total time spent sleeping with eyes closed is T2, then sleep efficiency = (T1/T2)*100%.
(1) When the sleep efficiency is lower than 85%, the total bed rest time will be directly reduced by 20-30 minutes in the next week, and continue to persist for one week, and the sleep efficiency will be judged after the end of the third week.
(2) When the sleep efficiency is equal to 85%, keep the bed time unchanged, and continue to insist on it for a week before judging the sleep efficiency.
(3) When the sleep efficiency is higher than 85%, increase the bed time by 20-30 minutes, and continue to insist on it for a week before judging the sleep efficiency.
Disadvantages: (1) The duration of sleep is often difficult to judge accurately, many people cannot estimate the time they fall asleep, resulting in inaccurate calculation, if they are calculating the sleep time before falling asleep, it is easier for people to lose sleep.
(2) If the sleep efficiency is too low, it will cause the patient to be depressed and aggravate anxiety.
(3) For most people, this method is difficult to adhere to for a long time.
2. Stimulation control therapy
Stimulus control therapy is an important part of cognitive behavioral therapy for insomnia and is recommended for the treatment of difficulty falling asleep and waking easily. Stimulus control limits the amount of time spent awake in bed and the behavior of staying in the bedroom or bed, with the goal of reinforcing the connection between bed/bedroom/bedtime time and rapid and stable sleep, and establishing a new conditioning process for reconnection, which mainly includes the following:
(1) Go to bed only when you are sleepy.
(2) Do not engage in activities unrelated to sleep in bed, such as looking at mobile phones.
(3) Leave the bed when you cannot fall asleep for more than 20 minutes or do not fall asleep again for more than 20 minutes after waking up.
(4) Go to bed only when you feel sleepy again.
Disadvantages: There are high requirements for housing, which is difficult to implement for a long time.
3. Positive Ideation Therapy
People with insomnia often think that they are in a terrible situation and are unable to cope with the problems caused by sleep disorders on their own. "It's hard to fall asleep when you have certain memory fragments circulating in your brain, or when you can't help but think about something." Positive Ideation Therapy can help patients clear all kinds of disorganized thoughts, rebuild sleep cognition, and reduce the adverse consequences of sleep disorders from a mental perspective. A simple positive mindset exercise is as follows:
Take a deep breath (it is recommended to do abdominal breathing), imagine pressing everything in your mind down with the inhaled gas (commonly known as pressing into the stomach) when you inhale, relax when you exhale, bring more attention into the breath, slowly forget about the things around you, immerse yourself in the breathing process, and let only "exhale - inhale - exhale - inhale" appears in your mind......
Disadvantages: It is often difficult to learn at the beginning, it takes an average of 4-6 weeks to form a habit, but once mastered and persistent, the effect is extremely obvious.
4. Relaxation therapy
There are many types of relaxation therapy, including muscle relaxation, mental relaxation, etc., which can reduce brain arousal and relax the muscles of the body and mind, but it needs to be done for a longer period of time. "If you want to fall asleep too much, you won't be able to fall asleep" refers to not being relaxed enough. At this time, it is necessary to develop the mindset of "it doesn't matter if you are asleep or not". It's easy to get into this state when you go with the flow and have no desires.
Disadvantages: For beginners, relaxation training is often regarded as a very important therapy, not only eager to master every detail, but also requires themselves not to wander, but they do not know that too much attention to the details itself is not relaxed, and the more you try to relax, the more anxious you are, the more you can't sleep.
In addition, hypnotherapy, reducing nap time (napping should be controlled within 30 minutes as much as possible, regardless of whether you are asleep or not, no more than 1 hour), choosing a quiet, well-shaded environment, and installing eye masks and earplugs are all helpful for insomnia treatment to varying degrees.
In general, there is no mandatory specific practice of cognitive behavioral therapy, most of it is in the mind, invisible and intangible, and it is difficult to quickly correct it in a short period of time. A large number of studies have confirmed that cognitive behavioral therapy should be used as the main treatment to solve insomnia, and the important reason for the poor effect is that cognitive correction emotion management is not in place, so it is often difficult for many of the above methods to achieve good results for people with poor self-emotion management. It's not CBT's fault, it's not that you don't learn enough and that your "doctor" isn't professional enough. The real practice of cognitive behavioral therapy requires the decision to use monotherapy or a combination of multiple therapies according to the insomnia of different individuals.
Remember, don't think that a certain therapy is not working for you, and if you think a cognitive behavioral therapy is not working, first assess whether your perception of sleep is reasonable, and then see if a certain behavioral therapy is used for more than 1 week, and finally check whether the method is effective for you.
Finally, insomnia treatment is a systematic project, and it is normal for it to be solved by individual efforts alone in a short period of time. For patients with intractable insomnia, under the guidance of professional doctors, after a period of comprehensive treatment, combined with appropriate cognitive behavioral therapy, I believe that everyone will have different gains. Finally, I wish you all a good night's sleep!
Liu Minqiang, Department of Surgical Anesthesiology, Shenzhen Third People's Hospital
bibliography
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