Maintain sleep disorder insomnia

Introduction Maintain sleep disorders and insomnia, characterized by frequent nighttime wakefulness. It is a type of sleep disorder. Sleep disorders (somnipathy) refers to various dysfunctions that occur during sleep-wake. The decline in sleep quality is a common complaint, and the number of long-term sleep disorders in the adult population can be as high as 15%. Generalized sleep disorders should include insomnia, excessive sleepiness, sleep-disordered breathing, and abnormal sleep behavior caused by various causes, including sleep walking, sleep panic, restless legs syndrome, and the like.

Cause

(1) Causes of the disease

It is currently believed that the main "sleep regulation center" is located in the ventral region of the hypothalamus, that is, the suprachiasmatic nucleus. In addition to causing disturbances in the sleep-wake cycle, this area of the disease can also cause changes in body temperature and eating activity.

(two) pathogenesis

The medical discussion of sleep begins with the search for a sleep center. The lesions located in the hypothalamus or the lateral wall of the third ventricle can produce persistent drowsiness, but non-physiological sleep can not explain the wake-sleep cycle. The anatomical parts currently associated with sleep are considered to be quite extensive, including at least the frontal lobe and the temporal cortex. The suprachiasmatic nucleus, the giant cell area of the midbrain cover, the blue spot, the interstitial nucleus, the medullary reticular formation inhibition zone, 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 leading peptide (DSIP) and the like.

For example, the suprachiasmatic nucleus and its associated retinal-hypothalamic bundle, with its own rhythmic activity, are the starting point for wake-up cycles in animals and may be part of a complex starting mechanism in humans. Another example is that the interstitial nucleus contains serotoninergic neurons, and the interstitial nucleus that destroys the pons can inhibit the occurrence of REM, while the interstitial nucleus that destroys the midbrain disappears; the blue plaque and the subluxory area contain noradrenergic nerves. In the awakening and REM, the frequency of discharge increases, while in SWS, it decreases. Destruction of the blue spot and the under-blue area can also cause REM to disappear. The S factor and DSIP in the neuropeptide can be concentrated into a medicament, which can produce SWS after injection.

an examination

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In order to clearly diagnose sleep disorders, clinicians must have high quality, detailed medical history, careful physical examination, and necessary auxiliary examinations.

Must be familiar with the normal sleep cycle of individuals of all ages. In infancy, one day and night can be roughly divided into three periods, namely, awake period, NREM sleep and REM sleep; in childhood, sleep is intermittent; adolescent sleep becomes very Regular: rarely wake up after falling asleep, sleep latency is short, and nighttime sleep quality is high. In the normal sleep mode of adolescents, delta wave sleep occurs most frequently, and occurs once every 45 to 90 minutes in the first half of the night.

Adults' sleep quality and time can be reduced, and the number of wake-ups after sleep increases. In the elderly, delta-wave sleep can be completely absent, sleep time is shortened, sleep is solid, and wakes up more often after falling asleep, but there are more naps during the day to supplement enough full-day sleep time. Multiphase sleep chart recording accurately identifies where non-specific clinical symptoms come from. In general, a complete NPSG study is more valuable than a daytime 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. REM sleep, delta wave sleep should be recorded, and activities, alertness, waking, and apnea should be routinely recorded. Insufficient ventilation, sleep latency and REM latency.

Diagnosis depends mainly on medical history. MSLT can detect that patients can have several naps during the first few hours of the day, the total daytime sleep time increases, and the sleep latency is normal or shortened. The characteristic manifestations are REM-based sleep (SOREMPs). The more SOREMPs appear, the more helpful the diagnosis of narcolepsy, and it is found that more than two SOREMPs can be diagnosed as narcolepsy. However, the specificity of SOREMPs for the diagnosis of this disease is not absolute. Arrhythmia, unplanned work, chronic sleep deprivation, obstructive sleep apnea, periodic leg movements during sleep, etc. can occur 2 or more times of SOREMPs, and clinical attention should be paid to the identification.

Differential diagnosis

Clinical classification of sleep disorders:

1. The international classification of sleep dysfunction is not standardized, and the diagnostic criteria of each country are not uniform. The main classifications include sleep disorders and deep sleep states.

(1) Sleep disorders:

1 endogenous sleep disorders: such as excessive sleep, insomnia, sleep apnea syndrome, restless legs syndrome, periodic leg movements.

2 Exogenous sleep disorders: such as poor sleep hygiene and sleep rhythm disorders (cross-time zone sleep rhythm disorder, work change syndrome).

(2) Deep sleep status includes non-NREM, sleep-related dream behavior, and REM behavior disorder.

2. Classification of the American Sleep Disorders Center

The Diagnostic Classification of Sleep and Awakening Disorders, published by the American Association of Sleep Disorders in 1979, classifies sleep-related problems into four categories.

(1) Insomnia: or as a barrier to falling asleep and maintaining sleep. This is the most common sleep disorder. It has been determined that there are three different types of insomnia, with chronic sleep disorders and complaints about day burnout. 1 sleep disorders insomnia, refers to difficulty falling asleep. 2 to maintain sleep disorders and insomnia, characterized by frequent nighttime wakefulness. 3 terminal insomnia, means wake up early in the morning, and can not fall asleep again. These types can occur alone or in combination, but it is rare to have overnight insomnia if the environment allows sleep.

(2) Excessive sleepiness disorder: The most common of these is narcolepsy. Typical symptoms are: sleep episodes; tripping; sleep paralysis or sleep sputum; illusion before going to sleep.

Another common type of excessive sleepiness disorder is sleep apnea. The patient repeatedly had a breathing pause during a deep sleep and suddenly awakened to resume breathing. This type of sleep disorder is characterized by a patient who wakes up in the morning and feels depressed and drowsy. It can also be seen as a barrier to falling asleep or staying asleep. In patients who complain of insomnia and apparent sleepiness during the day, there is a possibility of 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 more persistent symptom is the sleep phase delay syndrome, which means that you cannot fall asleep at the desired time for a long time. People with this condition can sleep well when they don't need to strictly follow the time program, 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 disorders occur.

(4) Deep sleep state: refers to some clinical manifestations of slow wave sleep, which is mostly 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 in sleep III and IV. That is to say, after sleeping for a period of time at night, the patient will sit up from the bed, or even walk away from the bed. The behavior is more dull, the consciousness is awkward, the question is not answered or the call should not be called. After walking for a while, sleep again, and the next day cannot be recalled. . Children's sleepwalking usually disappears naturally with age. Other such sleep disorders include sleep panic, enuresis, and night molars. The more common night terror in children occurs about an hour after sleep, which is characterized by sudden screaming. Adult night terrors are nightmares that can wake people up, as if they feel the chest being crushed by something. This happens in the stage IV of sleep. If the nightmare does not wake up, there are often no memories of dreams. Most of the enuresis occurs in stages III and IV of the first 1/3 stage of sleep at night.

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