Sleepless in the city
Studies show that the Chinese sleep much less than they did two decades ago owing to increased work demands. Insomnia is torturing an increasing percentage of urbanites. Long Congliu |
The man could only sleep two to three hours every night. Chronic insomnia made him develop a fear of sleep. Every night he found it difficult to switch off his brain.
The middle-aged entrepreneur went to one of China's most famous sleep disorder experts Li Shunwei, a neurologist from Peking Union Medical College Hospital.
"He is the kind of person chasing perfection. He thinks of increasing the business performance all day along," said Li.
Li said urban Chinese sleep much less than they did two decades ago as a result of the increased demands of work in booming China.
Insomnia, a major type of sleep disorder, is torturing an increasing percentage of urban people.
Doctors who specialize in this relatively new medical subject in China, say most sufferers bear the pains of insomnia quietly because of a lack of public education.
Today is World Sleep Day and China joined this event in 2002 in an effort to raise public awareness about the importance of sleep.
Sleep doctors are on the radio, TV and newspaper and even go to the streets and communities to spread the word about sleep disorders.
Two large-scale surveys had been conducted to understand sleep conditions, one in 2002 and the other in 2006. The questionnaire was handed out randomly in Beijing, Shanghai, Tianjin, Guangzhou, Nanjing and Hangzhou.
In 2002, more than 45 percent of respondents admitted to sleeping problems and last year the number rose to 57 percent. Less than 20 percent of respondents went to a doctor.
Doctor Li said the survey reflected a disturbing sleeping trend among young and middle-aged urban people and proved that sleeping disorders already had become a serious health hazard in the cities.
He said during a typical morning at his office, five of his eight patients are suffering insomnia.
Li has become a well-known sleep expert in China but is not a specialized sleep medicine practitioner. As a neurologist, he also needs to see patients with cerebro vascular diseases.
More than 20 years ago, sleep centers were established only within the respiratory departments of hospitals. These medical units treated people who had snoring problems.
Until the 1990s, more and more neurologists such as Li showed increasing interest in sleep disorders. Last year, they reached a common understanding on the guideline of diagnosis and treatment of sleeping disorders in China.
Doctor Li was optimistic that independent sleep departments or sleep centers would be established in two or three years.
Increased social pressure and competition are the major reasons for insomnia, Li said.
Stress is the No 1 reason for insomnia among doctor Li's patients, who can be scientists dogged by research projects, company employees striving to meet the business targets and even students worrying about entering the next higher school.
Bad relationships, traveling across many time zones, excessive noise, and having physical diseases, such as hypertension, cerebral arteriosclerosis, heart diseases, asthma, and gastric ulcers also cause insomnia.
Mary S. Esther, MD, the American Academy of Sleep Medicine (AASM) sleep expert, told China Daily, the number of hours of sleep in the US has also decreased in comparison to 50 years ago.
More than 20 million Americans complain about chronic insomnia, which can be associated with irritability, depression, and poor daytime performance.
"No one knows exactly why increased incidence of insomnia has happened, but it may in part relate to our busy lives and electronic advances," said Esther.
"Stress can cause an increase in difficulty initiating and maintaining sleep and plays a large role in insomnia," said David Bruce, MD and another sleep expert with AASM.
Insomnia is treatable and doctors encourage patients to talk about their problems instead of ignoring it or simply using sleeping pills for short-term treatment.
Sleeping pill abuse is a serious problem, according to Li.
He said insomnia patients are taking sleeping pills without the doctors' guidance and some doctors depend too much on prescribing the medicine to treat insomnia.
"Sleeping pills are often used to alleviate sleep disorders in the short term. For chronic insomnia patients, they could get addicted to the medicine. So the patients must often adjust the types and amount of the medicine as instructed by the doctors," said Li.
In China, older types of sleeping pills still account for the majority in the market, according to the doctor.
Abruptly discontinuing their use, however, may lead to a worsening form of insomnia, according to him.
In his clinical practice, he fixed the problem by giving behavioral therapy along with a gradual reduction of the amount of medication taken nightly until no forms of medications are consumed.
Shi Ming, vice director of Sleep Physiology and Pharmacology Branch of the Chinese Sleep Research Society and specializing in treating insomnia with traditional Chinese medicine, had given particular attention to the side effects of sleeping pills during past years.
He summarized four side effects. The first one is a demand for increased amount of medicine, for initially half a tablet to one, two till three.
A second is memory damage. A third is waking up with a thick head the next morning as the medicine could only alleviate shallow sleep. The final side effect is addiction. Without the medicine, some sufferers cannot sleep at all.
In fact, most of the patients come to him to treat sleeping pill addiction.
He said he helped most of the 670 patients alleviate the addiction syndrome through herbal medicine.
"TCM does not make them feel sleepy, but help to recover their disturbed sleep function," he said.
Sleep doctors in the US do not see sleeping pill addiction as a big problem as the older types of sleeping pills are rarely used there.
"Medications are used sometimes to help with sleep, but they should be used carefully and judiciously," said Esther.
"Modern sleeping agents are usually safe and not thought to be as habit forming as older types of sleeping pills."
"However, all medications can have side effects and the new sleeping agents can for some individuals lead to sleep walking, daytime sleepiness or confusion," said Esther.
"It is important that they are taken at bedtime and not too early, and that they are used when a patient has a sufficient amount of time (generally eight hours) available to sleep."
According to Bruce, the newer sleeping pills seem to be more targeted sleep therapy with less chance for abuse or addiction, but some of the older sleeping pills such as the Barbiturates can be more addicting and with more side effects.
Even the Benzodiazepines, which are commonly used in the US, can have more side effects. But he said most of the medicines used clinically are generally quite safe and addiction is not a large problem.
In the sleep medicine practice, doctors from China and the US both agreed that in treating insomnia it is important to try to improve sleep habits and not to rely on medication alone.
Medications may be used, but should be used as a part of a larger treatment approach, they said.
(China Daily 03/21/2007 page19)
