GW-ICC 2022: Chronic Insomnia, Behavioral Therapy and Medication Strategies for Adults!

At 19 pm on October 25, the opening ceremony of the 33rd Great Wall Cardiology Conference (hereinafter referred to as the "Great Wall Meeting") was presented
in the clouds under the eyes of everyone.
The conference is widely invited to be led by academicians, bringing together domestic heavy experts, linking up with international top celebrities, star-studded and wonderful
.

During the Great Wall Meeting, Duan Ying, a physician at the Sleep Disease Center of the General Hospital of the Chinese People's Liberation Army Air Force, shared the disease management content
of insomnia patients.

Sleep is one of the most important life activities of human beings and plays a vital role
in human health.
Sleep disorders are a common disease, unable to sleep, sleep well, lack of energy during the day, not only affect health, but also cause a great burden
on the psyche.

Regarding sleep disorders, the International Classification of Sleep Disorders edition 3 (ICSD-3) divides them into seven broad categories, including insomnia, sleep-related breathing disorders, central narcolepsy, circadian sleep-wake disorders, sleep paramorphisms, sleep-related movement disorders, and other sleep disorders
.
Insomnia is the most common sleep disorder, but not all sleeplessness in life is called insomnia
.
ISCD-3 requires that the diagnosis of insomnia must consist of three major elements: persistent sleep difficulties + adequate sleep opportunities + associated impairment
of daytime function.
That is to say, it is not objective reasons that make you unable to sleep, but subjective persistence that prevents you from falling asleep and affects daily life
.

Insomnia is common in women, chronic diseases, mental illness, substance users, and the elderly
.
ICSD-3 divides insomnia into 3 categories: short-term insomnia, chronic insomnia, and other insomnia
.
Among them, the prevalence of chronic insomnia is 10%, the prevalence of transient insomnia is 30%~35%, and transient insomnia.
Also known as temporary insomnia, it is a sleep disorder
that resolves on its own after a period of time.
It is different from "insomnia", which is mostly caused by psychological or spiritual reasons, and once the cause of insomnia is eliminated, it can return to a normal sleep state
.

Dr.
Duan believes that the diagnosis of chronic insomnia must meet the following items A~F at the same time:

There are many causes of chronic insomnia, which are more complex, and are relatively imperceptible in daily life, and there are the following treatments: cognitive behavioral therapy, drug treatment, physical therapy, and comprehensive therapy
.

Among them, cognitive behavioral therapy is a recognized and effective treatment, but the disadvantage is that it requires professional guidance, takes a long time, and requires patients to adhere to it
.
It includes therapeutic modalities
such as cognitive therapy, sleep restriction, stimulation control, and relaxation training.
Most insomnia patients use cognitive behavioral therapy, which belongs to the category of psychotherapy and can effectively avoid the side effects
of using drugs on the body.

When drug treatment is carried out on patients with chronic insomnia, the appropriate drug
should be selected according to the patient's age, disease characteristics, pharmacological characteristics, and patient wishes.
Short- and intermediate-potency benzodiazepine agonists or melatonin receptor agonists are preferred
.

At the end, Dr.
Duan shared the diagnosis and treatment process
of an insomnia case.
This is a 65-year-old female with a 5-year history of hypertension, who has been suffering from insomnia for 2 years, with difficulty falling asleep, light sleep, easy to wake up, and typical insomnia manifestations
after waking up.

Dr.
Duan initially diagnosed the patient with chronic insomnia, first gave cognitive behavioral therapy, followed up one month later, the patient felt that falling asleep had improved compared with before, and then found that the patient still had mouth breathing, in order to improve the patient's snoring, Dr.
Duan successively used positive airway pressure therapy + zolpidem therapy, positive airway pressure therapy + jaw band treatment, half a year later, the patient's sleep was improved
.

Dr.
Duan believes that as an insomnia patient, it is necessary to diagnose and treat through formal and professional medical channels, especially hospitals with sleep centers, which can carry out professional polysomnography monitoring
.
After a systematic and sound medical history and examination, determine the cause of insomnia, if it is secondary insomnia, the influence of the primary disease must be removed first, in order to cure insomnia
.