Insomnia is a condition characterized by persistently unsatisfactory sleep quality and quantity over an extended period. Among insomniacs, difficulty falling asleep is most common, followed by shallow sleep and early awakening. Some experience a lack of sleep sensation, with these symptoms often coexisting.
The duration of insomnia holds significant diagnostic importance. Brief insomnia lasting only a few days is considered normal, and diagnoses should not be overbroad. The following criteria for diagnosing insomnia are provided for reference:
1. Insomnia is nearly the sole symptom, including difficulty falling asleep, shallow sleep, easy awakening, vivid dreams, early morning awakening, or difficulty returning to sleep after waking, accompanied by feelings of discomfort, fatigue, or daytime sleepiness.
2. Preoccupation with the insomnia and its consequences.
3. The insomnia causes significant distress or impairment in psychosocial functioning.
4. The sleep disturbance occurs at least three nights per week and persists for one month or longer.
5. Not attributable to any physical illness or mental disorder. Insomnia and Sleeping Pills The use of sleeping pills is extremely widespread and casual, with this trend currently increasing. Electroencephalographic studies on drug-induced sleep from sleeping pills show it differs from physiological sleep, notably with a significant reduction in REM proportion.While drug-induced sleep may superficially fulfill sleep duration requirements, it actually subjects patients to prolonged REM deprivation—a state often more severe than in major insomnia. REM sleep is irreplaceable by slow-wave sleep (SWS) for human physiological needs. Self-reports from sleeping pill users confirm this: despite sleeping through the night, severe REM deficiency leaves them groggy upon waking, feeling as though they haven't slept enough.For patients with typical insomnia, while sleeping pills may aid sleep, they should not be used routinely. The duration of use should ideally not exceed 21 to 28 days. Shorter half-life medications or intermittent dosing (2 to 4 times per week) should be selected to minimize daytime sedation.
Long-term use of sleeping pills can lead to physical dependence.Individuals dependent on these drugs experience withdrawal symptoms when deprived of them. Among sleeping pills, drugs like Secobarbital, Methaqualone, and Amobarbital carry particularly severe dependency risks. The abuse of Amobarbital, in particular, has caused serious consequences worldwide. Therefore, clinicians and insomnia sufferers must re-evaluate sleep and insomnia, reassess the role of sleeping pills, and exercise caution in their use.
Psychological and Behavioral Interventions for Insomnia
Treatment of insomnia should first emphasize sleep hygiene. These measures can resolve one-time or brief episodes of insomnia. Specific methods include:
1. Maintain a regular sleep-wake schedule with consistent bedtimes and wake-up times. Avoid daytime napping (including holidays).
2. Limit time spent in bed to the duration of sleep disturbance prior to treatment.
3. Avoid substances that stimulate the central nervous system, such as coffee, strong tea, and alcohol.
4. Eat meals at consistent times, and avoid overeating at dinner.
5. Refrain from reading stimulating books or magazines before bed.
6. Engage in relaxing activities before sleep, such as massage, acupressure, or quiet meditation.
7. Maintain a comfortable bedroom environment with appropriate temperature, minimizing noise and bright light.
8. If unable to fall asleep within 20 minutes of lying down, get out of bed and return only when sleepy.
9. Engage in regular morning exercise after waking.
The most prominent characteristic of insomnia patients is an intense fear of sleep. As night approaches, they obsessively strategize how to fall asleep quickly while simultaneously dreading insomnia, creating internal conflict and a vicious cycle. One way to break this cycle is to adopt a "sleep as much as you can" attitude, letting things happen naturally.
Specialized psychological therapies include relaxation techniques, biofeedback, and cognitive-behavioral therapy, which should be implemented under the guidance of a clinician or psychologist.