The "plot bug" in episode 41 of "The Legend of Zhen Huan" actually hides a little-known fact that many people don't know!

"Wake up, it's time to take tranquilizers" is a long-standing and enduring meme in Chinese costume dramas.

For example, in episode 41 of "The Legend of Zhen Huan", at 33 minutes and 20 seconds, Concubine Xiang, who had denounced Concubine Hua but had not enjoyed the glory for a few days, had a premonition of her own end. She was restless every day and finally fell asleep, but was woken up by her maid, "My lady, drink the tranquilizer before going to sleep":

Image source: Screenshot from TV series

Netizens either laughed “hahaha” or joked “you slept wrong, get up and go back to sleep”... But as a wild animal scientist who has made the show so popular, I have to say something fair today: although this show has many scientific bugs, there may be nothing wrong with the plot.

What is Insomnia?

If you haven't learned anything about this, most people's concept of insomnia might be tossing and turning in bed, unable to fall asleep, and neither can others nor themselves.

But the definition of insomnia is actually broader. It includes not only difficulty falling asleep, but also difficulty maintaining sleep. Difficulty maintaining sleep includes poor sleep quality and insufficient sleep time.

In other words, not only the behavior of Su Shi and Zhang Huaimin, two idle people who couldn't sleep at night and looked at the moon, was a symptom of insomnia, but Yue Fei's situation of sleeping until three o'clock in the morning, "awakening from a dream of thousands of miles away" and "getting up and walking around the stairs alone" was also a symptom of insomnia.

Of course, it is not enough to just be unable to sleep or sleep well. It must also be accompanied by impaired daytime functions such as fatigue, sleepiness, poor concentration, decreased learning ability, prone to mistakes, irritability, etc., in order to be diagnosed as "insomnia". And the situation of sleeping less at night but still being energetic during the day cannot be considered insomnia, but can only be considered a natural gift.

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The causes and dangers of insomnia

According to research data from the Sleep Disorders Center at Stanford University School of Medicine, people who are dissatisfied with their sleep quality account for 8% to 18% of the total population, and 6% of people can be diagnosed with insomnia [1]. This shows that insomnia actually troubles many people.

Insomnia directly affects a person’s mental state and daytime performance, which not only reduces a person’s quality of life and affects their work and living conditions, but also affects their physical and mental health. The incidence of anxiety and depression in people with insomnia is significantly increased[2]. Sugar metabolism, cardiovascular system, and brain metabolism are also affected, which means a higher risk of chronic diseases such as cardiovascular disease and diabetes. The longer the insomnia lasts, the higher these risks may become[3].

There are many causes of insomnia.

On the one hand, insomnia exhibits certain genetic characteristics. People whose parents have insomnia symptoms are at higher risk of insomnia[4], and women are more likely to suffer from insomnia than men[5].

On the other hand, mental illnesses such as depression, anxiety, and post-traumatic stress disorder[5], various physical illnesses such as pain, diabetes, cardiovascular system diseases, respiratory system diseases, gastrointestinal diseases, and cancer[6], as well as the use of alcohol, caffeine, tobacco, and some drugs can all be causes of insomnia.

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How to treat insomnia

Looking at the case of Concubine Xiang in "The Legend of Zhen Huan", if we don't know the inside story of the emperor and the empress dowager poisoning her, then this is a typical case of insomnia caused by excessive mental stress, and the clinical manifestations of poor sleep quality (sleep cannot eliminate fatigue) and impaired daytime function (mental fatigue) also fully meet the diagnostic criteria. Under this premise, it is actually very reasonable for the imperial physician to prescribe "tranquilizer" for her and the maid to wake her up to drink the medicine!

So, how to correctly deal with various insomnia problems in real life?

Insomnia that lasts for less than one month is considered short-term insomnia, which is mostly caused by mental stress or physical discomfort. If it is expected that the insomnia problem can be solved after the mental stress disappears and the physical symptoms improve, you can temporarily observe while dealing with the mental stress and physical symptoms, or the doctor can prescribe short-term sleeping pills.

If insomnia symptoms persist after intervention, or if it is chronic insomnia, cognitive behavioral therapy and drug therapy are recommended. Drug therapy generally requires a doctor to evaluate and develop a medication plan.

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Cognitive behavioral therapy is the first-line treatment for chronic insomnia, and many of its contents are instructive for maintaining healthy sleep. If you want to have a good sleep, we can also learn from it in our daily life~

for example:

Establish a regular sleep cycle, going to bed and waking up at relatively fixed times every day;

Create a light-proof, quiet and comfortable sleeping environment;

Consume caffeinated foods only in the morning;

Do not smoke or drink alcohol in the evening, especially before going to bed;

Address issues that may affect sleep quality, such as thoughts that may interfere with sleep, being too hungry or too full, and urinating;

Get plenty of exercise, but not strenuous exercise close to bedtime;

Only use the bed for sleeping and sex, reinforcing the impression that the bed is "for sleeping";

…

However, insomnia is not always harmful to health. If Cao Cao also had insomnia, at least the soldier would not have died from "I like to kill people in my dreams".

References

[1] Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97-111. doi:10.1053/smrv.2002.0186

[2] Mason EC, Harvey AG. Insomnia before and after treatment for anxiety and depression. J Affect Disord. 2014;168:415-421. doi:10.1016/j.jad.2014.07.020

[3] Bertisch SM, Pollock BD, Mittleman MA, et al. Insomnia with objective short sleep duration and risk of incident cardiovascular disease and all-cause mortality: Sleep Heart Health Study. Sleep. 2018;41(6):zsy047. doi:10.1093/sleep/zsy047

[4] Drake CL, Cheng P, Almeida DM, Roth T. Familial Risk for Insomnia Is Associated With Abnormal Cortisol Response to Stress. Sleep. 2017;40(10):zsx143. doi:10.1093/sleep/zsx143

[5] Drake CL, Pillai V, Roth T. Stress and sleep reactivity: a prospective investigation of the stress-diathesis model of insomnia. Sleep. 2014;37(8):1295-1304. Published 2014 Aug 1. doi:10.5665/sleep.3916

[6] Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems [published correction appears in Sleep. 2007 Jul 1;30(7):table of contents]. Sleep. 2007;30(2):213-218. doi:10.1093/sleep/30.2.213

Author: Doctor Fei Dao Duan Yu

Review | Peng Zhiping Director of the Information Science Department of the China Sleep Research Society