Hangzhou Sleep Disorders Treatment Center (SDT), founded in 2011, is one of China’s largest and best-known sleep centers to serve patients from all over the country. The center is staffed with over 40 physicians, of whom 11 have a PhD or MS degree. With an integrative system of psycho-evaluation, psychotherapy, physical therapy, pharmacotherapy, Chinese acupuncture and cyber management, etc., SDT may suggest an approach customized to each patient for a sound effect. It’s been commonly known to people of Hangzhou, even of the whole province, to go for a prescription against insomnia in HSPH.
The clinic of sleep disorder, in 2016 only, has received a total of nearly 50,000 patients. The SDT inpatient department, with totally 138 beds available, houses on average 140 patients on a daily basis, and sees each month on average 260 patients cured and leave.
Mao Hongjing, the SDT Executive Director, the member of Youth Commission at Chinese Sleep Research Society, and the member of Behavioral Medicine Commission at Zhejiang Medical Association, has been for many years in practice on the psychological and drug treatment of insomnia. He invented a new model that applies the cyber technology to human sleep to place a whole-process control over the people with sleep problems.
Tang Guangzheng, Deputy Director of Mental and Physical Disorder Clinic, and the member of the Crisis Intervention Commission at Chinese Association for Mental Health, has been in practice for many years on the drug and psychological treatment of anxiety, insomnia and depression.
Assessment and Monitoring of Sleep
The 4 Compumedics Grael devices and 2 Somte ones, both as polysomnography monitors we have, enable us to fairly describe sleep structure, respiratory events, cardiac events and limb moves. In SDT, the patients’ sleep can be observed with technologies like night sleep monitoring, Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT) etc.. Besides, we also use hundreds of forms, including the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), the International Restless Legs Syndrome Study Group rating scale for the severity of restless legs syndrome (IRLS), to assess sleep disorders. The combination of monitoring and assessment enables us to make accurate descriptions and analyses of insomnia, narcolepsy, sleep apnea syndrome, restless leg syndrome and other disorders like night terrors, sleepwalking and bruxism, which lays the root for the precision of diagnosis and treatment customized to each patient.
Drugs for Sleep Disorders
Medication for insomnia includes prescription and over-the-counter drugs. The former mainly refers to traditional benzodiazepines (or sleeping pills as we understand), new non-benzodiazepines, melatonin receptor agonists, orexin, antidepressants, and antipsychotics. Over-the-counter medications include antihistamines, melatonin, L-tryptophan, and valerian tincture. Most prescription drugs, since easy to digest and quick to take effect, have played a vital role in clinical practices worldwide. New non-benzodiazepine drugs (like Zolpidem, Zopiclone, and Eszopiclone), which are considered effective, safe and independent, are now the first choice against insomnia. Yet, as the efficacy is still uncertain at times and adverse reactions may take place, using over-the-counter drugs are not a wise decision. However, there have been so many Chinese people, based on a thoughtless awareness of insomnia therapy, who said no to prescription drugs and decided to find a way out by themselves. It will be certainly an interference with the standard process later, and even may physically cause harm to the patients themselves. Therefore, we suggest to medicate our patients systematically with the instructions of an experienced doctor before they could have a good sleep without taking pills.
A TCM Solution to Sleep Disorders
As the Chinese people were able to cure insomnia thousands of years ago, they are quite experienced in this field. The Internal Medicine, a TCM classic compiled some 2,000 years ago, explained the cause of insomnia, while Zhang Zhongjing, a renowned doctor dating back to the Han Dynasty (202 BC-AD220), collected in his masterpiece On Febrile and Miscellaneous Diseases a number of remedies against insomnia that are proved still effective today. It is confirmed that the TCM therapy can boost one’s immunity by keeping the HPA axis balanced in function and improve neurotransmitters such as 5-HT. TCM may also be of help in the multi-target regulation of sleep and make patients feel easy. TCM alone has been proved highly effective in fighting mild and moderate simple insomnia, menopausal insomnia and transient insomnia. For chronic severe insomnia and insomnia with comorbid anxiety and depression, the efficacy of western medications can be significantly vaulted when an additional TCM therapy falls place. The medical compliance may also be arisen remarkably with less gastrointestinal reactions and side effects such as constipation, headache and fatigue when a TCM therapy is applied.
Psychotherapy for Sleep Disorders
Cognitive behavioral therapy, which has been highly recommended by the US Food and Drug Administration (FDA) to treat insomnia, is actually a non-drug approach to a better sleep via the adjustment of one’s sleep behaviors and perceptions. It includes sleep restriction, stimulus control, relaxation training, cognitive remodeling and sleep hygiene. All these techniques, which are adapted in SDT to the Chinese culture to take more effect for the Chinese patients, can be acquired in two weeks in hospital. In general, then, many with chronic insomnia can fall asleep without medications step by step within 2-3 months. It is also argued that cognitive behavioral therapy could be highly effective in preventing insomnia from relapse.
Physiotherapy
Accurate assurance, negligible side-effects and strong acceptability in clinical practices all enable physiotherapy to be a supplementary technique against insomnia. Existing physiotherapies in use for clinicians include phototherapy, repetitive transcranial magnetic stimulation, bio-feedback, and chronic cerebellar electrical stimulation, etc.. A painless, non-invasive and safe neurophysiological technique named transcranial magnetic stimulation, or TMS in short, is the use of the time-varying magnetic field to induce currents in the cerebral cortex, and thus to change the action potential of neurons there to affect the metabolism and electrical nerve activity in the brain, thereby generating biological effects on the stimulated and relevant areas. It has been introduced as a new solution to insomnia since the low frequency (≤ 1 Hz) rTMS can inhibit excitability of the cerebral cortex. TMS, in summary, can have one to sleep longer and better, shorten one’s sleep incubation, reduce one’s awakening time, and sharply lower the possibility of relapse.
杭州市第七人民医院