Still doing this when you have insomnia? There are risks, it is recommended to stop!

The recent hot weather and high stress have caused many people to have trouble sleeping, so they choose to take melatonin to help them sleep. But do you really understand melatonin? What exactly is melatonin? Are there any side effects if you take it for a long time? How can you relieve your sleep problems? Let's take a look at it below.

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Insomnia is generally not caused by not affecting the subjective sleep quality and work and life the next day.

Insomnia can be treated with psychotherapy, medication, and physical therapy;

Melatonin is more effective for people with circadian disorders (such as jet lag or shift work), but less effective for people with poor sleep quality, early awakening, and short sleep duration;

The recommended daily dose of melatonin is 1 to 3 mg. It is safe to take it in the short term and according to the prescribed dosage. Long-term use will affect the body's melatonin secretion, form dependence, and aggravate insomnia.

Melatonin is not recommended for pregnant women, breastfeeding women and children.

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Are you really suffering from insomnia?

In life, many people think they have insomnia because they sleep less, have difficulty falling asleep, or wake up too late. In fact, insomnia is a subjective experience, and it cannot be judged based solely on the amount of sleep time.

If you want to know whether you have insomnia, you need to see whether it affects your work and life during the day, and whether you have other health problems. Some people sleep for a short time, but it does not affect their subjective sleep quality and work and life the next day. This is not insomnia .

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According to the definition in the "Guidelines for the Diagnosis and Treatment of Insomnia in Chinese Adults" (2017 edition), insomnia refers to a subjective experience in which a person is dissatisfied with sleep time and/or quality despite having appropriate sleep opportunities and sleeping environment, and which affects daytime social function.

The main symptoms of insomnia are:

Difficulty falling asleep (taking longer than 30 minutes to fall asleep);

Persistent sleep disturbance (≥2 awakenings throughout the night);

Wake up early;

Decreased sleep quality and reduced total sleep time (usually less than 6.5 hours);

It is also accompanied by daytime dysfunction (mainly including fatigue, irritability or agitation, inattention or memory impairment, physical discomfort, cognitive impairment, etc.). According to the duration of the disease, insomnia can be divided into short-term insomnia (<3 months) and chronic insomnia (≥3 months). If symptoms of recurrent insomnia occur, whether it is chronic insomnia can be determined based on the duration of each insomnia episode.

How to solve insomnia?

The intervention methods for insomnia mainly include psychotherapy, drug therapy, and physical therapy.

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Psychological treatment mainly includes cognitive behavioral therapy (CBT-I). In most cases, CBT-I is provided by a licensed psychologist who has received training in this type of treatment. It can improve sleep by identifying the anxiety caused by insomnia patients about sleep and providing healthy guidance to eliminate the psychological burden. Psychological treatment is safe and has no side effects. It is recommended as a priority for most insomnia patients.

Medication can treat short-term insomnia , but for patients with long-term insomnia, it is necessary to consider the potential risks of adverse reactions and addiction.

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Physical therapy generally includes light therapy, transcranial magnetic stimulation, etc., and is usually only used as a complementary treatment.

For people with short-term insomnia, they should actively look for the factors that cause insomnia, try self-regulation and psychological treatment. If psychological treatment is ineffective, drug treatment should be carried out in the early stage to prevent short-term insomnia from turning into chronic insomnia. For patients with chronic insomnia, psychological treatment should be the first choice.

Can melatonin relieve insomnia?

Melatonin, also known as melatonin, is found in animals, plants, bacteria and fungi. In animals, melatonin is a hormone secreted by the pineal gland in the brain, and its main function is to regulate the sleep-wake cycle. At night or when the light is weak, the secretion of melatonin will increase, prompting people to fall asleep. During the day or when the light is strong, the secretion decreases, keeping people awake.

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For people with circadian disorders (such as jet lag or shift work), the effect of melatonin may be relatively good, while for people with poor sleep quality, early awakening and short sleep time, the effect of melatonin may be weaker.

In my country, melatonin is only approved for use in the production of health foods and cannot be used as a drug to treat insomnia. In other words, there is currently no definite clinical conclusion on whether melatonin can treat insomnia. It only has a certain promoting and auxiliary effect on sleep. Melatonin is not a sleeping pill and cannot replace drugs to treat insomnia.

Currently, drugs that can treat insomnia mainly include the following categories:

Benzodiazepines: such as long-acting diazepam (Valium), medium-acting estazolam, short-acting midazolam, etc. These drugs have obvious side effects , such as drowsiness and dizziness during the day the next day, and long-term use is associated with the occurrence of dementia.

Non-diazepine drugs: such as zolpidem, zopiclone, zaleplon, etc.

Antidepressants with hypnotic effects: These drugs have a sedative effect and can also be used to treat insomnia , especially when insomnia is accompanied by depression and anxiety.

What should I pay attention to when taking it?

When taking melatonin, it should be noted that the recommended daily dose is 1 to 3 mg . It is safe to take melatonin in the short term and according to the prescribed dosage, but the safety of long-term use is not yet clear .

It should be noted that long-term use of exogenous melatonin may lead to a decrease in the secretion of melatonin . If you become dependent on exogenous melatonin, it will lead to sleep disorders and worsen insomnia. Therefore, long-term use is not recommended .

In addition, the safety of melatonin for pregnant women, breastfeeding women and children is still unclear, so you should consult a doctor before taking it.

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As for drugs for the treatment of insomnia, according to the "Guidelines for the Diagnosis and Treatment of Insomnia in Adults in China" (2017 edition), insomnia patients can first choose non-benzodiazepine drugs such as eszopiclone and zolpidem. If they are ineffective, short- to medium-acting benzodiazepines can be considered. Secondly, antidepressants with sedative and hypnotic effects can be considered.

It should also be noted that the elderly are more sensitive to long-acting diazepam (Valium) and other long-acting diazepam than young people, and their metabolism rate is slower, which can increase cognitive impairment and make them more prone to falls. Therefore, it is not recommended for use in the elderly.

Author: Li Xue, PhD in Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College

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