This article is from WeChat official account:Cure occasionally (ID: to-cure-sometimes)< / span> , author: Chen Yi with, Producer: Su Wei Chu
The epidemiological survey released in 2018 shows that people with sleep disorders in my country account for about 38% of the total population, which is higher than the 27% of the global data given by the World Health Organization. According to the latest survey conducted by the China Sleep Research Association, more than 300 million people in China have sleep disorders. Among them, young people represented by the post-90s and post-00s have the most prominent sleep problems.
March 21 is World Sleep Day. “Occasionally Cure” find some young people suffering from sleep problems, and record their struggles and efforts.
For a long time, sleeping well was a luxury for Li Xiaoli.
The most serious period is 4 years of undergraduate degree. Every time she lay in bed, she had only one thought, “One night’s torture has begun again”.
The lights in the dormitory were turned off at 10 o’clock. She got into the thick blackout curtains, put on eye masks and ear plugs, thinking silently that it was time to go to bed. The roommates all climbed onto the bed, and she stopped all movements, praying that there would be no more loud noises.
She never brought her phone to the bed, but she was delayed in sleep. Lie motionless for a long time.
Anxiety continued to accumulate. She took off her blindfold and stared at the mosquito net on the ceiling to observe which hole was bigger than others, or where there were knots. His body was heavy, and his legs were not comfortable.
Three or four hours later, she is still sober. Anger came to my heart, “Why can everyone fall asleep, I can’t?”
She ran out of bed, trying to calm herself down.
The corridor is dark, and the washed clothes hang on the sides, extending forward, like a monster with a big mouth open. Li Xiaoli was once afraid of this atmosphere, but right now, she felt that there was nothing more terrifying than not being able to sleep.
When she was on the verge of collapse, she sent more than 30 messages to her mother, saying that she couldn’t stand it anymore and she wanted to leave school.
In the summer of 2019, in the 8th year of insomnia, Li Xiaoli, who has entered the workplace, made up her mind to go to the sleep clinic. In the sleep disorder clinic of Beijing Huilongguan Hospital, the 29-year-old received the expected diagnosis—chronic insomnia disorder.
Huilongguan Hospital’s Sleep Disorder Clinic Source: Photographed by the author
Insomnia is the most common sleep disorder. According to the third edition of the International Classification of Sleep Disorders, sleep disorders also include sleep-related breathing disorders, central narcolepsy disorders, sleep-wake circadian rhythm disorders, parasomnias, and sleep-related movement disorders.
In China, Li Xiaoli has hundreds of millions of patients.
Countless nights of insomnia, the troubles about grades and interpersonal relationships can’t be dissipated in Li Xiaoli’s mind; media practitioner Zhang Jiang is also awake, he shifts the shift once every two weeks, and finds that every time he comes to the day shift, he will lose The ability to fall asleep normally; a young girl from a small town in Hubei can always hear a heartbeat magnified several times when she suffers from insomnia. She is thinking about a question that “cannot find the answer”-do you want to resign for postgraduate entrance examination?
These young people have tried countless ways to save themselves, even going around in different departments. Eventually, some people entered the sleep clinic, trying to reconcile with sleep with the help of drugs or psychotherapy.
Long night without sleep
For a long time, Li Ning’s intuitive feeling is that more and more young people come to the sleep clinic for medical treatment.
She is the deputy chief physician of the Department of Neurology of Xuanwu Hospital of Capital Medical University. Since 2001, when the hospital opened a sleep clinic, she has participated in sitting consultations.
According to Li Ning’s estimation, at first, more than 90% of the patients were middle-aged and elderly people, especially the elderly. As they age, their physiological functions gradually deteriorate, and hormones such as melatoninDecreased secretion of serotonin, coupled with the impact of other chronic physical diseases, sleep generally shorter.
However, in recent years, the proportion of young people has increased to about 30%. Among them, the most troubled by insomnia.
Li Ning said that an important criterion for judging the need for medical treatment is whether daytime work efficiency and quality of life are affected. “Sleep is a subjective experience. The biggest misunderstanding is that sleep duration is one size fits all. Less than a few hours is insomnia.”
In 2017, the Sleep Disorders Group of the Neurology Branch of the Chinese Medical Association issued the “Guidelines for the Diagnosis and Treatment of Insomnia in Chinese Adults”, which stated that the main symptom of insomnia is difficulty falling asleep(the time to fall asleep more than 30 minutes), sleep maintenance disorder (wake up ≥ 2 times throughout the night), early waking, Decreased sleep quality and reduced total sleep time, accompanied by daytime dysfunction.
Correspondingly, the doctor will ask the patient to review in detail the overall sleep status of the past 2 to 4 weeks, including the sleep latency period. (preparing to go to bed until falling asleep Time), number of awakenings, duration and total sleep time, etc., and evaluate sleep quality and daytime function.
At the same time, the doctor should also understand the medical history of the patient and the history of other physical diseases, evaluate the mental state, and make a comprehensive judgment.
After collecting a detailed medical history, the doctor combined the sleep diary and some scales to assist in the diagnosis of insomnia to conduct clinical evaluation. Sometimes, objective methods such as polysomnography need to be included to identify whether they are combined with other sleep diseases.
Polysomnography Monitoring Source: Zhankuhailuo
If the patient’s sleep abnormalities and related daytime symptoms appear at least 3 times a week and last for more than 3 months, Will be diagnosed as chronic insomnia.
Most young people who seek help from the top three hospitals have developed chronic insomnia.
Li Xiaoli’s sleep problem began in 2011. At first, I just wake up frequently, “Lie down and get lost.” A year later, she found that once she woke up, no matter what time she was, she couldn’t fall asleep again.
Before and after 2015, she entered the worst period of sleep in her junior year. She was able to sleep for only one or two days a month, and only two or three hours of sleep for the remaining 20 days, and she was in a “half dream and half awake state” .
The various organs protested one after another. “I prepared a lot of messy pills, headache medicine for headache, stomachache medicine for stomach pain, and heartache medicine.”
Li Xiaoli can consume 20 tablets of ibuprofen in a box in two weeks. What supported her together were two 210-ml cans of espresso coffee that she drank after getting up. If she didn’t drink it, she would be so dispirited that she “did not want to open her mouth”.
In the early morning after staying up all night, she stood by the window of the dormitory and looked down, and some bad thoughts popped up in her mind.
“At the time I realized that I needed someone to save my life.”
The rhythm is out of order
In addition to insomnia, sleep rhythm disorders are also troubled by young people.
Zhou Shuangpao is the deputy chief physician of Huilongguan Hospital and has served as the director of the Sleep Medicine Center since 2017. In his outpatient clinic, about half of the patients with sleep rhythm disturbances are usually programmers, media practitioners, and film and television post.
He often heard a sentence from these patients, “996 is considered good.” The time for them to go home basically stabilized at 11 o’clock, and then wash again, and soon after 0 o’clock. “When they go to bed at one or two in the morning, they think it’s normal, because all their friends are at this time.”
Some people actively choose to stay up late. In their view, only the time spent on the bed and playing with the mobile phone is truly theirs. “Especially young people working in Beijing, Shanghai, Guangzhou and Shenzhen, most of them share rent with others and are not used to having fun in the living room.” Not doing short videos, visiting shopping websites, organizing group games, and not doing these seems to have let down their busy day.
The proportion of active or passive staying up late in different generations. Source: “2020 China Sleep Index Report”
Many times, retaliatory staying up late is accompanied by more difficult falling asleep. Zhou Shuangpao explained that the light-emitting screen of the mobile phone will inhibit the secretion of melatonin. The night is originally the peak of melatonin secretion. “If it is not reached or delayed, the sleep rhythm will be disordered.”
Others passively accept rhythm problems. Last summer, Zhang Jiang, who had just entered the workplace for a year, began to experience sleep problems. He works for a well-known media in Beijing. He shifts every two weeks. The day shift is from 9 to 5, and the night shift starts at 3 pm. The off time is not fixed. “Mostly at one or two o’clock, it will be until three or four o’clock in the evening. “.
Zhang Jiang is used to falling asleep listening to music. He set a 15-minute timer to play. He fell asleep before the music stopped. On the first summer night of insomnia, 15 minutes of music was looped once, and Zhang Jiang was still not asleep. Gradually, he kept increasing the number of cycles, and after adding 4 times, he decided not to listen to music again before going to bed.
Once transferred to day shift, he will suffer from insomnia.
When he couldn’t fall asleep, the sound was infinitely amplified. He was suffocated by the footsteps of the late residents in the community and the sound of his roommate turning on the tap. He took off the watch that could detect the quality of sleep. “It was too annoying to wear it. When I looked at the data the next day, it was 6 o’clock in the morning to fall asleep.”
The pain of sleep was recorded in various software scattered by Zhang Jiang.
After the rhythm disorder, he found that the opening time for the breakfast takeaway appointment was 3:30 in the morning. In the second half of last year, he ordered breakfast takeaway 8 times, the earliest one was at 3:37 in the morning.
Screenshot of early morning order Source: Photo courtesy of the respondent
“This means that I am not going to sleep that night.”
In the super chat of “Insomnia Sign-in” on Weibo, there are dozens of times he punched in, all of which were in bed for at least 3 hours. The online shopping platform still keeps his record of searching for sleeping pills late at night. Pressing the search button, the first pop-up is the national 24-hour free psychological assistance hotline.
the source of the problem
Dr. Li Ning said that only a small number of young people suffer from insomnia due to organic diseases. Most of the time, insomnia is mainly related to psychological factors.
This is consistent with the patient’s perception. According to a survey conducted by the Chinese Sleep Research Association, the top 3 causes of insomnia selected by them are emotional distress, life pressure and work pressure.
The “2020 China Sleep Index Report” issued by the China Sleep Research Association records the negative emotions of many insomniacs:
Young mothers in Shenzhen are overwhelmed by a monthly mortgage of more than 10,000 yuan, and they have to pay for their children’s education costs, and “both elderly people have no pensions”; the e-commerce customer service working in Shanghai hates co-workers The 26-year-old Internet practitioner has not been cared by his parents since he was a child, and is still criticized by the leaders for working crazy overtime. Loneliness and sadness always spread in the middle of the night…
Although he is not a doctor in the department of psychology, Li Ning also pays attention to the mental state of the patients when he sits in the sleep clinic. She found that for young people, the starting point of insomnia sometimes overlaps with important life nodes such as exams, job hunting, and entering the workplace.
Li Xiaoli clearly knows the source of her sleep problem.
For 3 years in high school, her study life was relaxed and happy, and her sleep maintained a length and quality that her classmates envied. After being admitted to a certain 985 college, she found that she was “working very hard” and her grades were still at a lower level in the middle reaches. Such a gap made her unacceptable.
Whenever she is awakened by her roommate’s dream, she falls into self-denial. Later, her grades gradually rose to the forefront, but her sleep was never better.
Interpersonal relationships also trouble her.
“In engineering majors, men have a strong voice. If they are not interested in the activities they are passionate about, they are easily labeled as out-of-group.”
Created a sleeping environment. A thick curtain is hung around the bed, “like a coffin”. Eye masks and earplugs have also become indispensable equipment. Wear them for 8 years. She tried her best to create an undisturbed environment, but soon discovered that interference from the outside world was inevitable.
Later, she looked for ways to help sleep in public accounts and shared posts, and focused on adjusting her state.
When insomnia is the worst, she will do 5 things every night:
Start exercise around 6 o’clock, “make yourself very tired”; eat less dinner to reduce the burden on the stomach and intestines; return to the dormitory, turn on the aromatherapy lamp, take out the foot-soaking bucket, and enjoy the scent of bergamot or lavender , Relax your feet while reading boring English books.
These five things are like a set of bedtime rituals, allowing Li Xiaoli to slowly withdraw from the state of learning during the day, “tell myself, I am going to bed”.
Only a few occasions, she can feel the effect of the ceremony, “very limited, maybe only 10% of the effect.” It is still those negative emotions that dominate sleep.
Zhang Jiang bought many internet celebrity products to improve sleep. The first batch was a foot bath bag and a memory pillow, which he soon included in the IQ tax. Later, he tried the melatonin taken by his colleagues all the year round, and on the recommendation of his friends, he bought a “food-grade sleep aid that can be bought in American supermarkets”. A bottle of several hundred yuan is not available. effect.
Young people like Li Xiaoli and Zhang Jiang are gradually becoming the main force in the consumption of sleep aids. According to the “China Sleep Index Report 2020”, from January to August 2019, the purchase of imported sleep aid products by post-90s generation increased by 118%, accounting for 62% of the total consumer population, exceeding the sum of other age groups.
The choice of products presents intergenerational differences. The first choices of young people are smart wearable devices and steam eye masks, and those born in the 70s and 80s prefer health-care foot baths and sleep aid pillows. However, more than half of people think sleep aid products are ineffective, and 10.1% even find it more difficult to fall asleep.
DifferentDifferences in sleep aid methods between generations. Source: “2020 China Sleep Index Report”
Zhou Shuangdao met many young people who failed to save themselves in the sleep clinic. Compared with middle-aged and elderly people, they have more channels to obtain information, and they have tried more methods: changing bedding, eating melatonin, listening to white noise, and even understanding relatively professional abdominal breathing, mindfulness meditation and other relaxation methods.
Zhou Shuangsha said that these methods have a certain effect, “but when insomnia develops to a more serious degree, relying on these alone will not make a significant improvement.”
A detour when seeking a doctor
Li Xiaoli also sought help from the medical system.
Mother took her to find a doctor in her hometown for medicine, and was told to eat more lamb. Since then, there must be mutton for three meals at home. “If I can’t eat it at night, I will stew mutton soup.”
Li Xiaoli feels nauseous when she smells lamb, but she still sleeps the same.
At the end of the holiday, she finally got rid of the “mutton curse.” Mother filled the suitcase with the divided soup medicine, and she obediently pulled it back to school and poured it in. Later, the decoction became a hawthorn-sized pill, and then into a bottle of hundreds of small balls. After half a year, she accepted the reality-none of these can improve her poor sleep.
In her junior year, she stood by the window of the dormitory, eager to realize that someone needed to save my life. This thought quickly evolved into, “The sleeping pill may be the thing that saved my life.”
She has the number of a general hospital. When the doctor heard “I can’t sleep and want to take medicine”, he prescribed medicine to her. She tried to give more information, but the other party hmmmmmm and perfunctorily, and quickly changed the topic to “a few times a day, a few pieces at a time”. Li Xiaoli noticed that he prescribed the same sleeping pill to several patients before and after.
This medicine did not give Li Xiaoli a new feeling. On the contrary, she couldn’t wake up and her thinking speed slowed down. She once lost confidence in seeking medical treatment and continued to find a way to save herself.
Sleep aid goggles and medicine Source: Zhankuhailuo
Jiang Quanming has a longer path to seek medical advice. According to his description, the medicinal materials he used can be piled up to fill 5 washing machines. Since high school, he has been looking for good doctors. Doctors have become more and more famous, and registration fees have also risen. Every time he felt that he should be saved, and returned with the medicinal materials in high spirits, but he never got his wish.
He once met a “good-hearted man” in Tieba, who claimed to be a disciple of a certain doctor, confident in his words, “it’s easy to cure”. Jiang Quanming took the medicine according to his prescription, but the situation worsened. “The whole person became very excited, and he couldn’t sleep at night, and he would have heart palpitations.” But the other party insisted that it was a normal reaction, and did not ask for further consultation, but only asked him to continue taking the medicine.
In recent years, Jiang Quanming has also been going around in various departments of Western medicine. He thought that he had never received the correct guidance. He just searched the Internet blindly. Some people said it was related to the kidneys, so he went to the nephrology department. Some people said that the blood supply to the brain was insufficient, and he went to the neurology department.
“I always go to some incorrect departments, so I didn’t get any substantial help.” The feedback from the doctors is the same. Let him relax his mind, exercise more, and prescribe some calming and brain-invigorating drugs.< /strong>.
The turning point occurred in the spring of 2020, the 10th year of insomnia. A doctor advised him to go to the sleep clinic for a try.
Many patients like Jiang Quanming did not know that there were outpatient clinics or departments specifically for sleep problems at the beginning of their treatment.
Sleep medicine in our country started late. In the first 30 years, it was mainly based on borrowing and translating the results of foreign countries. In 1981, the first psychiatric polysomnography laboratory was established in Sichuan, and research began. It has been nearly 20 years since the subject has made great progress.
Nationwide, institutions with independent sleep medicine centers like Huilongguan Hospital are rare. A paper published in the “Chinese Journal of Psychiatry” showed that my country’s existing sleep medicine centers have limited carrying capacity. The relevant medical workers are mostly from the Department of Respiratory Medicine, Stomatology, Otorhinolaryngology, and Psychiatry.
As a result, patients are scattered in different departments. Whether you can find a department that suits you in the first time, no one can say.
CBT-I group treatment in Huilongguan Hospital. Source: Image courtesy of Huilongguan Hospital
Most of the time, Li Xiaoli can benefit from the course. Every night, she sits on the carpet in the living room and relaxes according to the method taught by the therapist. The most common choice is the mentality method. A soft female voice guides her to imagine herself on the beach.
Li Xiaoli will see a park near her home, where there is a lake where wild ducks fly and stop. On the benches by the lake, people throw bread crumbs into the water from time to time to attract wild ducks to eat. Li Xiaoli felt that it was a healing place, and imagined that her body was getting lighter and lighter, and finally turned into a wild duck and flew into the sky.
What frustrates her is sleep restriction. This therapy reduces the non-sleep time in bed, increases the ability to fall asleep, and improves sleep efficiency.(The length of sleep is in The proportion of the total time spent in bed, the ideal value is more than 90%).
Patients participating in the treatment need to calculate their average sleep time per day according to their sleep diaries in the previous two weeks, and then calculate the time to lie down according to the time they wake up.
The average duration of Li Xiaoli is 6 hours. “Normally, I get up at 7:30, so I can go to bed at 1:30.”
In the group therapy class, she immediately questioned, “I can’t go to bed so late.” The therapist told her that sleep restriction did not reduce the length of sleep, “forcibly lying in bed is not good for you.” After some communication, she adjusted her wake-up time to 6 in the morning and strictly implemented the strategy of going to bed at 0 o’clock.
In the first week, she fell asleep almost within 15 minutes. But it became very difficult to get up, and I felt that “I slept very soundly, I have to wake you up.” I feel tired during the day and my heart will be a little uncomfortable.
Other team members have similar feedback, and the therapist encourages them to continue. If the average sleep efficiency reached 90% or more last week, you can go to bed 15 minutes earlier. In the next two to three weeks, Li Xiaoli’s discomfort became weaker and weaker, and her sleep became stable. Every night, after lying down for 10 to 15 minutes, she fell asleep.
It’s not just sleep that reconciles with it
Li Xiaoli never thought that her sleep could return to the state before the college entrance examination.
After graduate school, she no longer has the pressure of grades and relationships, but she also suffers from inexplicable insomnia once or twice a week.
After graduation, I moved to Beijing and often worked until the early hours of the morning. Sometimes I was lying in bed, but my mind couldn’t stop. For a while, it was “the four or five jobs on hand, which one is more anxious”, and then it was “to report tomorrow at 9 o’clock. What questions will the leaders ask”.
She lives with her boyfriend, and the other party doesn’t understand some of her practices, for example, why don’t you lie down all the time when you can’t sleep? Every time she strolled in the living room, she would see her boyfriend coming out of the bedroom and calling herself back. “His theory is that you should lie down if you can’t sleep, don’t move, don’t turn over, sigh, put your hands on your sides, close your eyes, and you will be able to fall asleep.”
The CBT-I course allows family members to listen in. Li Xiaoli’s boyfriend participated in the 4 weeks of activities. On the way home, the two have been discussing the content of the day’s course. The boyfriend felt that he might be more suitable for other methods, but he no longer forced Li Xiaoli to change.
After the treatment, Li Xiaoli continued to implement sleep restriction for one month. At the same time, some stimulus control methods are maintained: for example, do not do anything other than sleep in the bedroom; get up immediately if you have not fallen asleep 20 minutes after waking up.
Her sleep has never been bad again, even with increased work pressure or quarrels with her boyfriend. She can’t remember when she didn’t sleep well last time.
Part of the content of Li Xiaoli’s sleep diary during CBT-I acceptance. Source: Photo courtesy of interviewee
Jiang Quanming’s sleep has also stabilized a lot, and he can sleep about 7 hours a day. There are occasional fluctuations, and he will not be crazy. “If you don’t sleep well, you won’t be able to sleep well. Let it go, and it will probably be better the next day.”
3 months ago, the doctor changed the frequency of his follow-up visits from once every half a month to once a month, and the amount of medicine gradually decreased.
The medicine also improved Zhang Jiang’s sleep. Fortunately, he has never undergone a dressing change, and after only taking it for a month or two, he stopped the medication smoothly.
In the few months when the rhythm was chaotic, he felt resentful about his work several times, even though he had put in a lot of effort before passing the brutal selection.
Some thoughts came out: If you are not in this position, you will not have sleep problems. Students recruited from the same group of schools do not have to work night shifts, and even in the department, only their own group needs to shift work. “Why don’t others have to face this problem?”
The idea of changing jobs appeared briefly, but Zhang Jiang didn’t have that much confidence. “I didn’t get anything. I didn’t even get a Beijing account.”
After improving his sleep, his negative emotions about work are much less. The name of the unit is loud, the pressure is not too much, and the colleagues are also easy to get along with. Looking around, it is all the advantages.
Sometimes, for some people, reconciliation with sleep may not require medical treatment.
A young girl from a small town in Hubei only stayed in the sleep clinic for a few minutes. She did not want to reveal her confusion to the doctor.
Girls want to enter the postgraduate entrance examination, and the goal is to major in liberal arts with a worrying employment prospect, but the generous job is hard to give up. Relatives and friends who leave their hometown also need enough courage. She hopes to be more emotional than lacking, and she is worried that she will regret it after a few decades.
The second night after seeing the doctor, she was brewing sleepiness. When her mother returned from a trip, she sat by her bed, slightly drunk, and took the initiative to hold her hand.
With the faint light in the living room, the mother and daughter talked heartily for half an hour.
My mother told her, “I have discussed with your dad. Although the friends around you have good friends, you don’t need to worry, let alone doubt yourself, maybe it’s just that the fate is not there.”
The girl took advantage of the confusion about her resignation and postgraduate entrance examination, and her mother, who had originally opposed it, also relieved.
In her mother’s gentle voice, she gradually felt sleepy. After that night, she never had insomnia anymore.
At the request of the interviewee, the patients in the text are all aliases
This article is from WeChat official account:Cure occasionally (ID: to-cure-sometimes) , author: Chen Yi-containing