What Is Sleep Maintenance Insomnia?

Maintains sleep-disordered insomnia, characterized by frequent nighttime awakening. It is a type of sleep disorder. Sleep disorder (somnipathy) refers to various dysfunctions manifested during the sleep-wake process. Declining sleep quality is a common complaint, with up to 15% of people with long-term sleep disorders in the adult population.

Maintain sleep disordered insomnia

Broadly defined sleep disorders should include insomnia, excessive drowsiness, sleep disordered breathing, and abnormal sleep behaviors caused by various causes, the latter including sleep walking, sleep panic, restless legs syndrome, and so on.

Causes of maintaining sleep disorders insomnia

At present, it is believed that the main "sleep regulation center" is located in the anterior ventricular region of the hypothalamus, that is, the suprachiasmatic nucleus. In addition to causing disturbances in the sleep-wake cycle, changes in body temperature and eating activities can be caused by lesions in this region.

Medical exploration of sleep begins with the search for a "sleep center". Lesions located on the side wall of the hypothalamus or the third ventricle can produce long-lasting lethargy, but non-physiological sleep cannot explain the wake-sleep cycle. At present, the anatomical sites related to sleep are quite extensive, including at least the frontal base and the orbital cortex. The supraoptic nucleus, the mesangial giant cell area, the blue spot, the suture nucleus, the medulla oblongata area, and the ascending reticular system.

The transmitters involved include acetylcholine, dopamine, norepinephrine, adenosine, gamma-aminobutyric acid, serotonin, and neuropeptides such as S factor, delta sleep-inducing peptide (DSIP), and the like.

For example, the suprachiasmatic nucleus and its associated retinal-hypothalamic tract have its own rhythmic activity function, which is the starting point of the wake-sleep cycle in animals and may be part of a complex starting mechanism in humans. Another example is that the interstitial nucleus contains serotoninergic neurons. The destruction of the interstitial nucleus of the pontine can inhibit the occurrence of REM, while the SWS disappears when the interstitial nucleus of the midbrain is destroyed. The frequency of discharge increased in wakefulness and REM, but decreased in SWS. Destroying the blue and sub-spot areas can also make REM disappear. S factor and DSIP in neuropeptides can be concentrated into pharmaceuticals, which can produce SWS after injection.

Insomnia, not affected by other external factors, is characterized by frequent waking at night

Differential diagnosis of sleep disturbance insomnia

Clinical classification of sleep disorders:

1. The international classification of sleep dysfunction is not standardized, and diagnostic standards are not uniform across countries. The main classifications include sleep disorders and deep sleep.

(1) Sleep disorders:

Endogenous sleep disorders: such as excessive sleep, insomnia, sleep apnea syndrome, restless leg syndrome, and periodic leg movements.

Exogenous sleep disorders: such as poor sleep hygiene and sleep rhythm disturbances (sleep rhythm disturbances across time zones, work shift syndrome).

(2) Deep sleep states include non-NREM, sleep-related dreamwalking, and REM behavior disorders.

2. Classification of the Sleep Disorders Center in the United States. The 1979 Classification of Sleep and Wake Disorders, published by the National Association of Sleep Disorders Center, classifies sleep-related problems into four broad categories.

(1) Insomnia: Or called obstacles to falling asleep and maintaining sleep. This is the most common sleep disorder. Three different types of insomnia have been identified, with complaints of chronic sleep disturbance and daytime burnout.

Insomnia due to falling asleep means difficulty falling asleep.

Maintain sleep disordered insomnia, which is characterized by frequent nighttime awakening.

terminal insomnia refers to waking up early in the morning and not falling asleep again. These types can occur alone or in combination, but overnight insomnia is less common when the environment allows sleep.

(2) Excessive sleepiness disorder: the most common of which is narcolepsy. Its typical symptoms are: sleep onset; cataplexy; sleep paralysis or sleep paralysis; hallucinations before falling asleep.

Another common type of hypersleepiness is sleep apnea. The patient repeatedly stopped breathing during deep sleep and suddenly woke up to resume breathing. This type of sleep disorder is characterized by patients waking up in the morning and feeling lethargic and lethargic. It can also be considered as an obstacle to falling asleep or maintaining sleep. Patients who complain of insomnia and drowsiness during the day may have sleep apnea.

(3) Obstacles to the sleep-wake time program: including temporary circadian rhythm disturbances caused by high-speed flight and temporary sleep disturbances caused by changes in working hours. A longer-lasting symptom is the sleep phase delay syndrome, which is the inability to fall asleep at the desired time for a long time. People with this symptom can sleep soundly when they do not need to strictly follow the time schedule, such as on weekends or holidays. It appears that the onset and length of sleep are affected by species-specific biological rhythms, and when these rhythms are not synchronized, sleep disturbances occur.

(4) Deep sleep state: refers to some clinical manifestations that appear in slow-wave sleep, most of them during sleep III and IV, but the sleep process itself is not abnormal. One of them is sleepwalking, which is more common in children and adults with snoring. Sleepwalking often occurs during sleep stages III and IV. That is, after sleeping for a period of time at night, the patient will sit up in bed, or even walk around leaving the bed, the behavior is stiff, conscious, refusing to answer questions or refusing to respond, sleeping after walking for a while, can not recall the next . Children's sleepwalking generally disappears naturally with age. Other such sleep disorders include panic during sleep, enuresis, and night molars. The more common night terrors in children appear about an hour after sleep and are characterized by sudden screaming. The night terror of an adult is a nightmare, which can awaken people as if they feel something pressed on their chest. This happens during sleep stage IV. If the nightmare is not awake, there are often no dream memories. Enuresis also occurs mostly in stages III and IV of the first third of the night's sleep.

For the clinical manifestations of various sleep disorders, see the following sections of this chapter.

In order to clearly diagnose sleep disorders, clinicians must be of high quality, ask a detailed medical history, conduct a careful physical examination, and use the necessary auxiliary examinations.

You must be familiar with the normal sleep cycle of individuals of all ages. In infancy, day and night can be roughly divided into 3 periods, that is, awake period, NREM sleep and REM sleep; sleep in childhood is intermittent; sleep in adolescents becomes very Regular: Rarely wake up after falling asleep, short sleep latency, and high night quality sleep. In this normal sleep pattern of adolescents, -wave sleep occurs most frequently, occurring approximately every 45 to 90 minutes during the first half of the night.

Adults' sleep quality and time can decrease, and the number of waking up after sleep increases. In the elderly, delta wave sleep can be completely absent, sleep time is shortened, and the firmness of sleep is lost. There are more wake-ups after falling asleep, but there are more naps during the day to supplement adequate sleep time throughout the day.

Polyphasic sleep chart recording can pinpoint where nonspecific clinical symptoms come from. In general, a complete NPSG study is more valuable than a day nap study. In summarizing the data of the NPSG study, the total bed time, total sleep time, and sleep latency should be summarized to determine the effectiveness of sleep. Records of REM sleep and delta wave sleep should be available. Activity, alertness, wakefulness, and apnea should be recorded routinely. , Hypoventilation, sleep latency and REM latency.

The diagnosis is mainly based on medical history. MSLT can find that patients can have several naps in the hours of a day, the total daytime sleep time is increased, the sleep latency is normal or shortened, and the characteristic manifestation is sleep initiated by REM (SOREMPs). The more SOREMPs appear, the more it helps the diagnosis of narcolepsy. It is found that more than two SOREMPs can generally be diagnosed as narcolepsy. However, the specificity of SOREMPs for more than one diagnosis is not absolute. Arrhythmias, unplanned changes in work, chronic sleep deprivation, obstructive sleep apnea, and periodic leg movements during sleep can all occur 2 or more SOREMPs, which should be identified clinically.

Insomnia, not affected by other external factors, is characterized by frequent waking at night.

According to a World Health Organization survey, 27% of people have sleep problems. The Global Sleep and Wellness Program, sponsored by the International Mental Health Organization, launched a global event in 2001-setting March 21 each year, the first day of spring as "World Sleep Day". The theme of World Sleep Day 2004 is "Focus on Sleep Health".

There are many reasons for sleep problems, such as a certain sleep disorder, physical illness, emotional factors, lifestyle (excessive drinking of coffee and tea), and environmental factors (noise, congestion or pollution) and so on. As long as the problem is identified, it is possible to find a solution to it and re-establish regular sleep.