In the quiet consulting room in the afternoon, a woman with a sad face came in. As soon as I was seated, the patient, who claimed to be Zhang, said to me with a crying voice: I have been insomnia for two months. What should I do?
Doctor: please tell me about insomnia.
Ms. Zhang (hereinafter referred to as Zhang): it's hard for me to fall asleep at night, and it's easy for me to wake up when I fall asleep, especially when I wake up at three or four o'clock in the morning, I can't go to sleep any more, and I feel it's hard.
How is your diet?
Zhang: I've had a bad appetite since I lost sleep. My appetite has been greatly reduced. I've lost nearly 5kg in the last two months.
D: are there any other physical changes?
Zhang: defecation is not as smooth as before, sometimes sweating, flustered, nervous, do not know if there is a heart problem.
Do you think there is any change in your emotional state? Zhang: I'm in a terrible mood. I don't know what to do. D: do you have any confidence in coming here for treatment?
Zhang: to be honest, I feel hopeless. I don't want to live.
Is the problem so serious?
Zhang: Yes, I must have done something wrong to others before, but now I have been punished. I can't imagine the future. I don't have the courage to bear more pain.
What if we help you? Zhang: it's useless. No one can help me.
D: you have a university culture and a good career. The future should be beautiful.
Zhang: since I began to lose sleep, my brain reaction has been much slower, and my memory has obviously declined. My brain is empty, and I have no energy to finish my work. I just get paid in vain, so I quit my job. I don't want to do anything in the future.
D: what are you doing now?
Zhang: I'm not interested in anything. I don't want to do anything. Every day is like a year. I don't know how long I can last.
D: what do you think is the main reason for this?
Zhang: insomnia! Insomnia has not improved, and my condition is getting worse.
D: what treatment have you undergone?
Zhang: I used to take hypnotics, but they began to have some effect. Now they are completely useless.
The accompanying family members told me that since the onset of insomnia, Ms. Zhang's mood has been gradually depressed, sighing all day, her interest in work and entertainment has declined significantly, her past enthusiasm for life has disappeared, and she sits at home alone most of the time, sometimes crying; He often complains and blames himself, saying that he has nothing to do with it, which has affected his family. Recently, he has repeatedly expressed the idea of suicide. The comfort and encouragement of his relatives and friends have no effect, and the self medication of sleep drugs has no obvious effect. For fear of an accident, her family sent her to the clinic.
So, is Ms. Zhang really insomnia? In fact, she is suffering from depression. So I told this woman that she saw insomnia as a major problem because she didn't understand the reasons behind it.
Insomnia is one of the common symptoms of many mental disorders, especially in the clinical manifestations of patients with depression. Most of the early symptoms of depression onset, even the only symptom is insomnia. The characteristic symptom of insomnia is' wake up early ', which is one or two hours or even three or four hours earlier than the patients before the disease. But in fact, insomnia symptoms such as difficult to fall asleep, shallow sleep and dreaminess, easy to wake up, and difficult to fall asleep after waking up often appear in the clinical phase of depression in varying degrees, and some depression do not have the phenomenon of 'early waking up', but show other forms of insomnia symptoms mentioned above. Once in depression, insomnia often persists throughout the whole course of depression. Therefore, many patients with depression, like Ms. Zhang, think that they are insomnia and often seek treatment for insomnia. Some patients even buy sedative hypnotic drugs to improve insomnia. The common phenomenon is that insomnia seems to have improved at the beginning of medication, so that patients believe their judgment more. However, with the development of the disease, patients feel that although the dosage of hypnotics is increasing, they still don't get enough rest, their energy is getting worse and worse, their mood is getting worse and worse, and even have other physical problems, such as loss of appetite and libido, palpitation, chest tightness, shortness of breath, etc Recently, even insomnia may be aggravated, just helpless to come to the psychiatric department. Ms. Zhang's illness changes and medical experience is just like this.
So, how to identify depression through insomnia?
As the name suggests, the core of depression is' depression ', that is, depression. Depression is an inner experience, which we usually judge by the specific symptoms. The specific symptoms of depression are as follows: lack of interest -- a significant decline in interest, loss of enthusiasm and motivation in life; hopelessness -- disappointment or even despair of the future; helplessness -- such as the lonely boat in the sea, the prison on a precipice, no one to help, no one can help; sense of incompetence -- self-consciousness of being worthless, even self blame, self guilt; The decline of memory, attention and thinking ability is also a common feeling of patients. In addition, insomnia, loss of appetite and libido, weight loss, visceral dysfunction, such as chest tightness, shortness of breath, dyspepsia, constipation, etc. are accompanied to varying degrees. Many patients also have symptoms of anxiety, suspicions of serious illness, and even delusions and hallucinations.
Once it is clear that the essence of the so-called 'insomnia' is' depression ', the vast majority of depression can be cured by symptomatic treatment. As depression improves, so does insomnia. Therefore, when you or your relatives and friends have insomnia, especially when insomnia is not cured, you must be alert to the problems behind insomnia.