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*For reference by medical professionals, March 21 is World Sleep Day.
"Sleep well and live awake.
" Patient: Doctor, I think I have insomnia.
.
.
Doctor: Why do you think so? Do you have any symptoms? Patient: I can only fall asleep at 1 o'clock every night, and I wake up at 7 o'clock.
Doctor: Only short sleep time? Are you sleepy in the morning? Do you have problems such as sleepiness and lack of concentration during the day? Patient: No, I just feel that I have a short sleep time, but I don't have any of what you said, and I don't feel very tired when I wake up in the morning.
So the question is.
.
.
Is this patient insomnia? Does she have sleep disorders? If it were your patient, how would you diagnose it? How would you evaluate it? Next, I will answer you how to conduct an effective clinical evaluation? 1.
Medical history collection A.
Ask the medical history, including: specific sleep status, medication history, possible substance dependence, pregnancy, menstruation, breastfeeding, perimenopausal and other physical conditions.
B.
Obtain the specific content of the patient's sleep status: manifestations of insomnia, work and rest time, sleep-related symptoms, and the impact of insomnia on daytime functions.
2.
Ask the patient if they have the habit of recording a sleep diary.
A.
The sleep diary usually lasts for 2 weeks.
B.
In 2 weeks, patient records: daily bed time, number of night awakenings and time of each awakening, total bed time between the beginning of going to bed and waking up, abnormal night symptoms (abnormal breathing, behavior, movement, etc.
), records The degree of impact on energy and social functions during the day, and the lunch break.
C.
Calculate sleep efficiency=[(actual sleep time/time in bed)×100%].3.
Perform scale assessment A.
Common scales: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Generalized Anxiety Scale (GAD-7), State Trait Anxiety Inventory (STAI), Epworth Sleepiness Amount Table (ESS), Fatigue Severity Scale (FSS), Quality of Life Questionnaire (SF-36), Sleep Belief and Attitude Questionnaire, Early Morning and Night Sleep Questionnaire.
B.
The clinical application can be selected according to the specific conditions of the patient.
4.
Objective evaluation A.
Due to neuropsychological and behavioral changes, patients with insomnia are prone to deviations in their self-assessment of their sleep status, and their grasp of the actual sleep time is inaccurate.
At this time, objective evaluation should be selected for screening.
B.
Evaluation methods: All-night polysomnography (PSG), PSG multiple sleep latency test (can be used to identify narcolepsy and increased daytime sleepiness and other diseases), activity recorder (used to identify circadian rhythm disorders) Sleep arousal disorder).
Through the above medical history inquiry, system review, scale evaluation and objective evaluation, we have basically grasped the patient's current sleep state.
If the patient has been diagnosed with sleep disorder, is it insomnia? Insomnia is a kind of sleep disorder.
The core of diagnosing insomnia can be summarized as: "abnormal sleep symptoms + daytime functional impairment related to insomnia", the specific diagnostic criteria, but it is also carried out around these two points.
Figure 1: The diagnostic process of insomnia The definition of insomnia cannot escape the term explanation! So what is the definition of insomnia? Insomnia refers to the subjective experience of being dissatisfied with sleep time and/or quality despite having suitable sleep opportunities and sleeping environment, and affects the subjective experience of daytime social functions.
Key words: suitable sleep opportunities, sleep environment, dissatisfaction, and affects daytime social functions (emphasis!!!) Chronic insomnia must meet 1 to 6 items at the same time: 1.
Symptoms of abnormal sleep: difficulty falling asleep, difficulty maintaining sleep , Wake up earlier than expected, and reluctant to go to bed at the right time.
There are one or more of the above.
2.
Daytime dysfunction related to insomnia: fatigue or general discomfort, inattention, social and academic dysfunction, emotional irritability or irritability, daytime sleepiness, hyperactivity, impulsivity, decreased energy and physical strength, Prone to errors and accidents, excessive attention to sleep problems, or dissatisfaction with sleep quality.
There are one or more of the above.
3.
The above symptoms cannot be explained simply by not having a suitable sleep time or an inappropriate sleeping environment.
4.
The above symptoms persist at least 3 times a week.
5.
The above symptoms last at least 3 months.
6.
Difficulties in sleeping and awakening cannot be better explained by other types of sleep disorders.
Knock on the blackboard! Memory tips "Shanshan (33-3 times a week, at least 3 months) can't fall asleep at night (abnormal sleep), can't wake up during the day, and finally resigned by the boss (daytime dysfunction), and feel very depressed (often) Accompanied by emotional changes)!".
The duration of short-term insomnia-related symptoms is less than 3 months and/or the frequency has not reached 3 times a week.
So, back to our clinic, is the above patient diagnosed with insomnia? Answer: NO! Insomnia is a subjective experience.
You should not rely solely on sleep time to determine whether there is insomnia.
Although the patient has a short sleep time, there is no subjective sleep quality deterioration and no daytime functional impairment, so it cannot be regarded as insomnia.
If the patient still persists, we can suggest that the patient record a sleep diary and take a small book to write down his specific sleep content (the content has been mentioned just now~, if you can’t remember, please go back and read it again); at the same time, you can improve the related scale evaluation (For example: GAD-7, etc.
) See if the patient is accompanied by other functional diseases.
So, if you sleep late and sleep time short, as long as your daytime social functions are not affected, you are not insomnia! As the saying goes, "As long as you sleep well, fifteen minutes can be worth two hours!" It is not unreasonable.
Now that you are all here, you must be particularly wondering, how can you sleep for fifteen minutes to two hours? After all, the saved one hour and 45 minutes can be used for mobile phones, right? So stay tuned for the next breakdown!
"Sleep well and live awake.
" Patient: Doctor, I think I have insomnia.
.
.
Doctor: Why do you think so? Do you have any symptoms? Patient: I can only fall asleep at 1 o'clock every night, and I wake up at 7 o'clock.
Doctor: Only short sleep time? Are you sleepy in the morning? Do you have problems such as sleepiness and lack of concentration during the day? Patient: No, I just feel that I have a short sleep time, but I don't have any of what you said, and I don't feel very tired when I wake up in the morning.
So the question is.
.
.
Is this patient insomnia? Does she have sleep disorders? If it were your patient, how would you diagnose it? How would you evaluate it? Next, I will answer you how to conduct an effective clinical evaluation? 1.
Medical history collection A.
Ask the medical history, including: specific sleep status, medication history, possible substance dependence, pregnancy, menstruation, breastfeeding, perimenopausal and other physical conditions.
B.
Obtain the specific content of the patient's sleep status: manifestations of insomnia, work and rest time, sleep-related symptoms, and the impact of insomnia on daytime functions.
2.
Ask the patient if they have the habit of recording a sleep diary.
A.
The sleep diary usually lasts for 2 weeks.
B.
In 2 weeks, patient records: daily bed time, number of night awakenings and time of each awakening, total bed time between the beginning of going to bed and waking up, abnormal night symptoms (abnormal breathing, behavior, movement, etc.
), records The degree of impact on energy and social functions during the day, and the lunch break.
C.
Calculate sleep efficiency=[(actual sleep time/time in bed)×100%].3.
Perform scale assessment A.
Common scales: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Generalized Anxiety Scale (GAD-7), State Trait Anxiety Inventory (STAI), Epworth Sleepiness Amount Table (ESS), Fatigue Severity Scale (FSS), Quality of Life Questionnaire (SF-36), Sleep Belief and Attitude Questionnaire, Early Morning and Night Sleep Questionnaire.
B.
The clinical application can be selected according to the specific conditions of the patient.
4.
Objective evaluation A.
Due to neuropsychological and behavioral changes, patients with insomnia are prone to deviations in their self-assessment of their sleep status, and their grasp of the actual sleep time is inaccurate.
At this time, objective evaluation should be selected for screening.
B.
Evaluation methods: All-night polysomnography (PSG), PSG multiple sleep latency test (can be used to identify narcolepsy and increased daytime sleepiness and other diseases), activity recorder (used to identify circadian rhythm disorders) Sleep arousal disorder).
Through the above medical history inquiry, system review, scale evaluation and objective evaluation, we have basically grasped the patient's current sleep state.
If the patient has been diagnosed with sleep disorder, is it insomnia? Insomnia is a kind of sleep disorder.
The core of diagnosing insomnia can be summarized as: "abnormal sleep symptoms + daytime functional impairment related to insomnia", the specific diagnostic criteria, but it is also carried out around these two points.
Figure 1: The diagnostic process of insomnia The definition of insomnia cannot escape the term explanation! So what is the definition of insomnia? Insomnia refers to the subjective experience of being dissatisfied with sleep time and/or quality despite having suitable sleep opportunities and sleeping environment, and affects the subjective experience of daytime social functions.
Key words: suitable sleep opportunities, sleep environment, dissatisfaction, and affects daytime social functions (emphasis!!!) Chronic insomnia must meet 1 to 6 items at the same time: 1.
Symptoms of abnormal sleep: difficulty falling asleep, difficulty maintaining sleep , Wake up earlier than expected, and reluctant to go to bed at the right time.
There are one or more of the above.
2.
Daytime dysfunction related to insomnia: fatigue or general discomfort, inattention, social and academic dysfunction, emotional irritability or irritability, daytime sleepiness, hyperactivity, impulsivity, decreased energy and physical strength, Prone to errors and accidents, excessive attention to sleep problems, or dissatisfaction with sleep quality.
There are one or more of the above.
3.
The above symptoms cannot be explained simply by not having a suitable sleep time or an inappropriate sleeping environment.
4.
The above symptoms persist at least 3 times a week.
5.
The above symptoms last at least 3 months.
6.
Difficulties in sleeping and awakening cannot be better explained by other types of sleep disorders.
Knock on the blackboard! Memory tips "Shanshan (33-3 times a week, at least 3 months) can't fall asleep at night (abnormal sleep), can't wake up during the day, and finally resigned by the boss (daytime dysfunction), and feel very depressed (often) Accompanied by emotional changes)!".
The duration of short-term insomnia-related symptoms is less than 3 months and/or the frequency has not reached 3 times a week.
So, back to our clinic, is the above patient diagnosed with insomnia? Answer: NO! Insomnia is a subjective experience.
You should not rely solely on sleep time to determine whether there is insomnia.
Although the patient has a short sleep time, there is no subjective sleep quality deterioration and no daytime functional impairment, so it cannot be regarded as insomnia.
If the patient still persists, we can suggest that the patient record a sleep diary and take a small book to write down his specific sleep content (the content has been mentioned just now~, if you can’t remember, please go back and read it again); at the same time, you can improve the related scale evaluation (For example: GAD-7, etc.
) See if the patient is accompanied by other functional diseases.
So, if you sleep late and sleep time short, as long as your daytime social functions are not affected, you are not insomnia! As the saying goes, "As long as you sleep well, fifteen minutes can be worth two hours!" It is not unreasonable.
Now that you are all here, you must be particularly wondering, how can you sleep for fifteen minutes to two hours? After all, the saved one hour and 45 minutes can be used for mobile phones, right? So stay tuned for the next breakdown!
