Sleep Health

Some insomnia patients often complain when seeking medical treatment that they have pre - occupation related to sleep whenever night falls or when they try to fall asleep. That is, they show a unique sense of fear before going to bed, worrying about being unable to fall asleep and feeling irritable or having mood swings. At the same time, although such patients still have a state of arousal before sleep, which is manifested as a feeling of drowsiness when going to bed, they become extremely "energetic" once they lie in bed, with an increased level of alertness. Falling asleep every night becomes an arduous task. Some other patients often need to keep the TV or lights on when trying to fall asleep. This unique and painful form of insomnia is called: somniphobia, also known as "Sleep Anxiety". Somniphobia refers to the fear of difficulty falling asleep or the fear of sleep - related events (nightmares, sleep paralysis or traumatic events) that may occur during sleep. They may be afraid of not being able to fall asleep or what might happen after falling asleep. Some patients may even extend their worry or entanglement throughout the day, feeling anxious about having difficulty getting enough sleep. Some people may feel extreme pain when thinking about or trying to fall asleep, so they try to stay awake for as long as possible, eventually forming a vicious cycle of sleep disorders.

Somniphobia is a specific phobia, which is an intense fear of a specific object, situation or animal. "Specific phobia" is an anxiety disorder in which a person has a strong, persistent and unreasonable fear of a certain type of specific object or scenario, is afraid of the consequences that follow, and either actively avoids the feared object or scenario or endures it with intense fear and anxiety. Most people with specific phobias know that the anxiety they feel is extreme, but it can sometimes be difficult to control the anxiety symptoms. Clinically, patients with somniphobia suffer much more than those with insomnia. Because insomnia patients can still fall asleep by diverting their attention, relaxing their mood and other methods, while patients with somniphobia have difficulty overcoming their fear. Foreign data shows that more than 12% of adults have specific phobias. Women are twice as likely to have specific phobias as men. At present, the exact cause of somniphobia is not clear in the medical field. However, it should be recognized that sleep anxiety is not simply a sleep disorder. When doctors point out that these patients have anxiety disorders during the consultation, they often ask in disbelief, "I have no pressure in my work and life. How can it be an anxiety problem?"

There are many factors that may lead to the fear of sleep. Risk factors that induce the onset include insomnia, parasomnias (such as nightmares or sleep paralysis), generalized anxiety disorder (GAD), post - traumatic stress disorder (PTSD), a history of trauma at night, narcolepsy, panic disorder, restless legs syndrome, sleep apnea, etc. Long - term sleep deprivation can lead to physical health problems. Continuous sleep deprivation increases the risk of the following diseases: depression, diabetes, heart attack, hypertension, obesity, and stroke. Many people with somniphobia may also abuse sleeping pills for a long time in an attempt to fall asleep. Untreated somniphobia may increase the risk of drug addiction (substance use disorder) or alcoholism.

This unique and painful form of insomnia and its far - reaching effects may lead to sleep deprivation and related health problems. Due to the strong sleep - related concerns, some people may have difficulty concentrating throughout the day. It can also interfere with interpersonal relationships, work, school and other aspects of life. In severe cases, the phobia can also cause various physical symptoms to occur frequently. Patients may experience: changes in breathing or shortness of breath (dyspnea), chest pain or tightness, chills or cold sweats, hyperventilation, rapid heart rate or palpitations, nausea or vomiting, uncontrollable tremors or shaking, difficulty concentrating, repeated dizziness, etc. As a result, they may go from one hospital or clinic to another for help. Children who are afraid of falling asleep may also: cuddle up to their caregivers, cry uncontrollably, get out of bed multiple times throughout the night, have tantrums, and resist going to bed.

How to treat somniphobia?

First of all, both doctors and patients should have an understanding of this kind of disease and its far - reaching effects. Based on this, the correct diagnosis and treatment plan can be found. It can help calm the anxious mind and relieve the chaotic thoughts. Patients can improve their quality of life by adjusting their living habits and mental state; strengthening communication with relatives and friends and sharing their feelings can not only keep them away from isolation, but also relieve anxiety and relax themselves through empathy, so as to have a healthier mood and regain the peace brought by the night, which is conducive to restoring good sleep.

Try to reduce the risk of developing somniphobia. Although there is no specific method to prevent somniphobia at present, the quality of sleep can be improved by developing good sleep hygiene and living habits. For example: go to bed at the same time every night and get up at the same time every morning; establish a pre - sleep routine, including performing the same relaxation activities every night, such as playing soft music; avoid eating or drinking any beverages containing caffeine or alcohol before going to bed; avoid taking naps during the day; only go to bed when you feel sleepy; exercise regularly; avoid using computers, smartphones or TVs for at least one hour before going to bed; keep the bedroom at a suitable cool temperature and in the dark; maintain a healthy weight, eat nutritious foods and limit processed foods, and exercise regularly; sleep in a room with a suitable temperature and in the dark; avoid long - term use of sleeping pills.

If the symptoms have seriously affected one's night sleep and daily life, one should seek help from a doctor in time. If necessary, treatment with the help of drugs can be carried out under the guidance of a professional doctor. Similarly, there is currently no single cure for somniphobia. Cognitive - behavioral therapy (CBT) and exposure therapy are usually the most effective current treatment methods for phobias. Professional doctors can help you identify and overcome sleep - related fears to relieve your anxiety symptoms.

Drugs can relieve sleep - related anxiety symptoms. Insomnia is the most common physical symptom in anxiety disorders and is also one of the important factors for evaluating the clinical treatment effect of anxiety disorders. Due to the adverse reactions of benzodiazepine (BZD) sleeping pills, selective serotonin reuptake inhibitors (SSRI) / serotonin - norepinephrine reuptake inhibitors (SNRI) have become the first - line clinical anti - anxiety drugs at present. The range of drug selection for the treatment of anxiety - related insomnia is relatively narrow. SSRI/SNRI with sedative effects are the first - choice drugs for the treatment of anxiety - related insomnia. The short - term combined use of SSRI/SNRI and hypnotics is currently a common treatment plan for anxiety - related insomnia. New - type hypnotics have been used more frequently in clinical practice in recent years due to their fewer adverse reactions.

It must be pointed out that at present, many medical workers in clinical practice are not aware that with the emergence of some atypical antipsychotic drugs, benzodiazepine (BZD) sleeping pills are no longer used as the first - line drugs for the treatment of insomnia. They often give BZD sleeping pills to insomnia patients without analyzing the causes, especially chronic insomnia patients (chronic insomnia disorder patients have three characteristics: unstable mood, fatigue, and symptoms of anxiety and depression, and most of them are accompanied by mental disorders such as anxiety). This wrong practice of long - term use of BZD sleeping pills for such patients should be noted and changed. BZD sleeping pills should not be used continuously for more than one month. In principle, they should be used on an as - needed basis (it is advisable to use them for three days and then stop for two days) to prevent the adverse effect of abuse and addiction.

At the same time, it must be reminded that mental disorders such as anxiety and depression are chronic diseases, and their drug treatment must last for three months to half a year. In severe cases, it may even require one - year or lifelong treatment. The increase or decrease of drugs during the process of the disease change should be adjusted through the doctor's evaluation. The dosage should be reduced slowly and should not be suddenly stopped. It should also be noted that the long - term drug treatment of mental disorders is a completely different concept from the addiction caused by the long - term use of BZD sleeping pills.

SSRI has a definite curative effect on anxiety disorders. Escitalopram is an SSRI with sedative effects, which can improve the sleep quality of insomnia patients. A double - blind placebo - controlled study suggests that escitalopram can significantly improve the insomnia symptoms of patients with generalized anxiety disorder; however, some SSRIs may cause anxiety and insomnia. For example, paroxetine can significantly reduce rapid eye movement (REM) sleep, prolong the REM latency period, and reduce sleep continuity. It is generally believed that SSRIs may worsen insomnia symptoms and increase nighttime awakenings. In the early stage of treating anxiety disorders or depressive disorders accompanied by insomnia, if SSRIs are selected, sleep - promoting drugs should be combined to achieve better results.

Trazodone is a serotonin antagonist/reuptake inhibitor (SARI), which has an antagonistic effect on α1 - adrenergic receptors and an anti - histamine effect. It can increase the total sleep time (TST) and is effective in the treatment of depressive disorders, anxiety disorders with depressive symptoms, and emotional disorders after drug - dependence withdrawal.

Agomelatine is a new - type antidepressant. It exerts pharmacological effects by activating melatonin receptors (MT1/MT2) and antagonizing 5 - HT2C receptors. It can not only improve depressive symptoms but also increase TST. A randomized double - blind placebo - controlled study suggests that agomelatine is effective for generalized anxiety disorder, and significant improvements have been obtained in the secondary endpoint evaluations including sleep quality.

For patients with anxiety - related insomnia, anti - anxiety drugs such as buspirone, tandospirone, and flupentixol melitracen can be used during the day, and antidepressant and anti - anxiety drugs with sedative effects such as escitalopram, trazodone, and mirtazapine (SSRIs/SNRIs) can be used before bedtime, as well as a low - dose (less than 100mg, with sedative and anti - anxiety and anti - depressive effects) antipsychotic drug quetiapine. Good treatment effects can also be achieved.

β - blockers, such as propranolol (Inderal®) or atenolol (Tenormin®). These drugs can relieve physical anxiety symptoms, such as a rapid heartbeat.

Benzodiazepines, such as alprazolam (Xanax®) or lorazepam (Ativan®). BZD drugs are widely used in anxiety - related insomnia and help to relieve symptoms in the short term. To prevent addiction and abuse, they are currently often recommended to be used in combination with other drugs for the short - term treatment of anxiety - related insomnia.

Non - benzodiazepine (BzRA) hypnotics, such as esopiclone, Stilnox, etc., have no anti - anxiety effect. In the treatment of anxiety - related insomnia, they are recommended to be used in combination with antidepressants in the short term to increase the anti - anxiety effect of antidepressants and effectively improve early - stage anxiety - related insomnia.