World sleep day | more than 300 million adults have sleep disorders! Can’t sleep. Do you want sleeping pills or not?

One third of a person’s life is spent sleeping, but quite a few people do not sleep well. The 2018 China Sleep Index report released by the sleep medicine professional committee of the Chinese Medical Association shows that the incidence of insomnia among Chinese adults is as high as 38.2%, and more than 300 million people have sleep disorders. When people suffer from insomnia, should they take sleeping pills? What are the good ways to help us sleep well?

As World Sleep Day approaches, invited Professor Liu Zhonglin, chief neurologist of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, to tell us about ” the science of sleep”.

Avoid two extremes: dependence on medication and elimination of medication

When talking about whether to take sleeping pills, Liu Zhonglin did not tell us how to take them in a hurry, but told the story of two insomniacs first.

Aunt Zhang, 72, has been troubled by insomnia for more than 20 years. Since she stopped menstruation around the age of 50, aunt Zhang began to use estrogen and sleeping pills for treatment after going to other hospitals due to symptoms of hot flashes, hyperhidrosis, anxiety and insomnia. After continuous treatment for about one year, aunt Zhang’s symptoms of hot flashes and hyperhidrosis gradually decreased, but sleeping pills could not stop all the time, and the dosage was increasing. At first, she only ate one tablet a day, and after a year she ate three tablets a day. Now she still can’t sleep after eating six tablets a day, which makes Aunt Zhang feel very painful.

Contrary to aunt Zhang, 63-year-old uncle Wang did not dare to use sleeping pills for fear of addiction. Since he retired three years ago, uncle Wang has suffered from insomnia, palpitations and unstable blood pressure. After questioning the medical history, it turned out that uncle Wang’s wife had been suffering from insomnia for 10 years and was addicted to sleeping pills every day. Uncle Wang worried that he would repeat the mistake of his old wife. For three years, he had been afraid to use sleeping pills. He began to worry about insomnia every day when the sun went down, forming anxiety and fear of insomnia, thus aggravating palpitations and unstable blood pressure.

The experience of aunt Zhang and uncle Wang in treating insomnia is actually a microcosm of many patients. Liu Zhonglin told that many patients have gone to two extremes clinically. Some patients take sleeping pills all the year round, resulting in addiction dependence. There are also quite a few patients who are worried about dependence on sleeping pills and dare not take them at all.

In fact, these two kinds of mentality are wrong. Liu Zhonglin said that at present the treatment of insomnia is mainly drug-based, so rational drug use is still an effective means to improve insomnia. When drugs are needed, they should be used scientifically and rationally in order to make the treatment effective.

According to Liu Zhonglin, before using hypnotic drugs, doctors generally make a systematic clinical evaluation of patients, formulate a rational drug use plan, and adopt the principle of ” taking drugs on demand, intermittent administration, minimum dose, short-term use and gradual withdrawal”, so that patients can obtain therapeutic effects while avoiding drug addiction. Therefore, patients do not have to abstain from medication.

At present, sleeping pills commonly used clinically include benzodiazepines and non-benzodiazepines, both of which belong to category II psychotropic drugs in our country. Long-term or large-scale use of sleeping pills may indeed lead to abuse or dependence. In view of this, Liu Zhonglin has repeatedly stressed that patients must follow the doctor’s advice and must not use drugs arbitrarily.

” For the elderly, benzodiazepines are the drugs that are more prone to abuse. The potential hazards of these drugs to the elderly include memory decline, drowsiness, delirium, dependence, cognitive impairment, etc.” Liu Zhonglin pointed out that there are data showing that the probability of elderly people falling after taking benzodiazepines exceeds 40%. Non-benzodiazepine or melatonin receptor agonists are recommended when selecting sedative and hypnotic drugs for the elderly population. When there are over-dose or long half-life drugs in the prescription, the doctor should instruct the family members to prevent drug addiction.

If already addicted, how to stop using sleeping pills?

Discontinuation of benzodiazepines can lead to a series of withdrawal symptoms, including anxiety, restlessness, tremor, sweating, irritability, insomnia, epilepsy, etc., especially for patients who have been used for more than 8 weeks.

If drug addiction has occurred, patients should slowly and gradually stop using benzodiazepines. For example, reduce the original dose by 25% in the first week and the second week respectively, and then reduce the original dose by 10% every week until the final complete reduction stops. In order to prevent severe withdrawal symptoms, the dosage should be reduced at a moderate speed at high dose and slightly at low dose. Serious patients can consider using other drugs to gradually replace and then gradually reduce.

Liu Zhonglin also mentioned that cognitive behavioral therapy for insomnia (CBT-I) and stimulation control therapy also have the effect of improving sleep. In addition to drug therapy, these methods or combined therapies can also be selected to treat insomnia. In addition, insomnia caused by anxiety and depression cannot be treated with sleeping pills alone, but requires a regular full course of anti-anxiety and depression treatment.

Extended Reading: Ten Tips for Improving Insomnia

1. Develop the habit of relaxing yourself before going to bed, such as taking a warm bath 1 hour before going to bed, soaking your feet in hot water, reading for several minutes, listening to music for a while, etc. Avoid tension and learn to control your emotions.

2. Use less irritant drugs or diet after the afternoon, and do not drink caffeinated beverages such as coffee within 6 hours before going to bed. Avoid alcoholic beverages and smoking 1-2 hours before going to bed.

3. If you are still trapped by a lot of problems before going to bed, it is recommended that you write them down and their solutions in 30 minutes.

4, form the habit of regular activities, with regular exercise after breakfast or afternoon is appropriate; Less strenuous exercise after the afternoon, let alone before going to bed.

5. Do not go to bed until you feel tired and want to go to bed. Do not rigidly observe the ” bedtime”; Don’t get into the habit of working in bed, reading books, newspapers, TV or eating.

6, lying on the bed to breathe gently, after exhaling screen for a few seconds to inhale again, in order to increase the carbon dioxide content in the body, can help sleep.

7. Sleepers affected by reflux of gastric juice may as well elevate their pillows.

8. If you cannot fall asleep for 10-15 minutes, it is recommended that you get up and go to other rooms to do some things, such as reading books, newspapers or TV, etc., and then go to bed until you are sleepy.

9. For those who have too many dreams, they can take ” dream continuation therapy”, that is, continue to recall dreams when awake, so that they have an ending, which can reduce the number of dreams.

10. Get into the habit of getting up regularly. Whether you feel like sleeping or not, getting up early is an effective way to deal with insomnia at night. The lunch break should not be too long and the habit of falling asleep frequently should not be formed.

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