【Local Medical】Sleep-aiding effect is not fully supported by medical evidence. Do not take melatonin casually.

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Text: Yang Qianni Organizer: Liang Yingxiu

In Malaysia, one out of every three Malaysians suffers from insomnia, and insomnia can indeed cause many health problems. Everyone is looking for a good night’s sleep. Among them, melatonin health products are portrayed as sleep aids.

But in fact, its effect on insomnia has not yet obtained sufficient medical evidence and is listed as a drug. Many countries, including Malaysia, do not encourage random consumption of melatonin.

(Kuala Lumpur) Associate Professor Ng Chong Guan, psychiatry consultant at UMMC, pointed out that before getting into the topic, the public should clarify whether they are insomnia or do not want to sleep.

“Actually, many people do not suffer from insomnia, but deprive themselves of time, leading to lack of sleep. They refuse to go to bed even though they have enough time, resulting in the inability to maintain a normal rhythm of sleep. This bad habit is also called sleep deprivation ( sleep deprivation).”

33.8% of citizens have symptoms of insomnia

He said that insomnia can be divided into 3 stages clinically: difficulty falling asleep, easy awakening during sleep and reduced sleep time. Tossing and turning in bed for more than half an hour, feeling confused or active and unable to fall asleep, waking up the next day with poor energy, feeling tired or having a headache, are symptoms of difficulty falling asleep.

The second type is being able to fall asleep, but unable to maintain sleep, sometimes waking up or light sleep, for example, being awakened by the partner’s slight turning over. Due to poor sleep quality, even if they sleep for 8 hours, they still feel that they have not had enough sleep when they wake up the next day.

The third type is those who wake up prematurely, they wake up more than one hour earlier than the usual habitual wake-up time. For example, a person who used to wake up when the alarm clock rang at 8 o’clock, but now wakes up before the alarm clock goes off, gradually wakes up even in the early morning, and can’t fall asleep again.

“Therefore, insomnia is not considered as insomnia. An obstacle occurs at any stage and lasts for a period of time. For example, it has been like this three or four days a week for three months. It affects daily life and cannot concentrate on work or school. classified as insomnia.”

According to a study conducted by the International Medical University (IMU) in 2008 on 1,611 adults aged 30 to 70, about 33.8% of the nationals have symptoms of insomnia, while 12.2% of those with real chronic insomnia.

According to his personal experience, it is normal for more than 30% of people to have symptoms of insomnia.

The Elderly Difficulty Sleeping Due to Biological Factors

“Insomnia can be divided into two types: primary and secondary according to the etiology. Primary insomnia is very rare, because everyone is born with a biological clock, and the body has a ‘fixed schedule’ for endocrine production at different times. It’s much harder to become disordered without a secondary cause.”

“Basically, it is very difficult to see insomnia in a person who is happy, free from anxiety or stress, eats well, exercises regularly, and does not smoke or drink. In my more than 20 years of clinical experience, only 2 patients with insomnia were looking for There is no reason. Furthermore, have you ever seen a baby with insomnia? It can be seen that most people are not born with insomnia, and the problem is often caused by secondary factors.”

He pointed out that the environment is one of the external factors causing insomnia, and different age groups will have different troubles. Teenagers usually stay up late because of academic or relationship problems, game addiction and lack of sense of identity on social media are also sources of stress for modern teenagers.

Adults often suffer from insomnia because of family disputes, relationship or marital life, and finances. It is worth mentioning that although many adults still have stable careers and families during the epidemic, they suffer from mental stress and suffer from insomnia.

“Although their life looks ideal to outsiders, they are not happy themselves. This may be related to their own personalities such as perfectionism, stubbornness, dissatisfaction or competitiveness.”

He said that the insomnia of the elderly is often due to physiological factors, such as chronic kidney disease, lung disease or cancer, and may cause psychological problems. They often require many medications, some of which can cause side effects such as frequent urination. Facing life and death, as well as worrying about children, the elderly can also find it difficult to sleep due to psychological stress.

Many people will ask, is insomnia all due to mental illness? Anxiety, depression, panic, or bipolar disorder can all be intrinsic to insomnia. In fact, 9 out of 10 patients who came to the psychiatric department mentioned insomnia in their first sentence. Perhaps out of fear of being labeled as mentally ill, they rarely directly report problems such as panic attacks, depression or hallucinations.

In addition, substance abuse, such as drugs and alcohol, is more likely to cause insomnia problems these days. In fact, sleep aid after drinking is a misunderstanding. After all, it can only make people drowsy for a short time. After the effect of alcohol wears off, there will be a withdrawal reaction, which will make you more excited and difficult to fall asleep.

Insomnia drugs are divided into 4 classes

He revealed that the treatment of insomnia also depends on whether external factors can be resolved in a short period of time. For example, the cases of broken love are not too difficult, and they will improve after accompanying them through the painful period. If the problem cannot be solved overnight, such as growing up in a broken family, parents are divorcing, etc., they need to treat their mental illness and insomnia. If the insomnia is caused by side effects of drugs or physical diseases, you can also ask the attending doctor to adjust the drugs.

Drugs commonly used clinically to treat insomnia are mainly divided into 4 categories,

That is, benzodiazepines (Benzodiazepines, BZDs),

Non-benzodiazepines (non-BZDs), also known as Z-drugs,

Orexin receptor antagonists and psychotropic drugs,

Examples include antidepressant, schizophrenia, and bipolar medications.

“BZDs and non-BZDs are first-line drugs that target different parts of the neurotransmitter gamma-aminobutyric acid (GABA) receptors, while psychiatric drugs work by reducing dopamine concentrations in the brain to promote sleep.”

He said that in view of the possible side effects of dependence on BZDs and Z drugs, doctors will only prescribe a short-term course of treatment (one or two weeks of dosage), which should generally not exceed 4 weeks, and will recommend that you try not to take it as soon as you can fall asleep. If the insomnia is still not relieved, you have to switch drugs to avoid drug addiction.

“Actually, sleeping pills are strictly controlled in our country. Under the Psychotropic Act (Psychotropic Act), a prescription must be issued by a doctor before purchase, and the whereabouts of each sleeping pill must be recorded. Not only that, Malaysia can use it every year. The number of sleeping pills and sedatives that can be imported and produced by pharmaceutical factories is limited. This is not only because of their side effects, but also because of the hope that doctors will “pay attention to pennies and pennies” when taking medication, and will not prescribe sleeping pills to patients at will.”

Melatonin unlisted drugs

Regulate biological clock non-sleep

Melatonin is a hormone secreted by the pineal gland in the brain.

Endocrine is carried out according to the changes of the biological clock. For example, the body will secrete more cortisol in the morning, so that we can greet the new day energetically, and the retina will send a signal to the relaxation after feeling the light (blue light brightness). fruit body to inhibit the secretion of melatonin.

In the dark environment at night, the secretion of melatonin will increase, reducing the body’s alertness and making people feel drowsy.

Huang Zhangyuan pointed out that the oil lamps and candles used by people in the past had only a small amount of blue light. Therefore, the time from secretion to reduction of melatonin in the body can be as long as more than ten hours; fluorescent lamps and electronic screens widely used by modern people contain a large amount of blue light. Blue light, the production of melatonin is affected to a certain extent, so sleepiness usually does not occur until very late, and only lasts for about 8 hours.

Whether it can “upper the brain” is still doubtful

So does supplementing melatonin from outside the body have a sleep-promoting effect? “So far, the effect of melatonin on insomnia has not obtained sufficient medical evidence, and it has not been listed as a drug. Many countries, including Malaysia, do not encourage the use of melatonin. Melatonin on the market is usually in the form of Sold in the name of health supplements, in fact, they can only adjust biological clocks such as jet lag. Many people mistakenly believe that melatonin has a sleeping effect, which is a wrong idea.”

Not only that, whether taking non-self-secreted melatonin can “upper the brain” and play a role is still in doubt. The blood brain barrier is a barrier that protects the brain from foreign substances. Because of this, most drugs fail to pass through the blood into the brain, which is one of the reasons why many anticancer drugs fail to treat brain tumors effectively.

Adjust daily routine to help sleep

Currently, there is only one drug for the treatment of severe depression, agomelatine, which has been confirmed to activate melatonin receptors and indirectly improve sleep conditions. The melatonin products on the market have very little effect, and most of them are excreted after taking it, so the public is not encouraged to buy and take it.

“If a little bit of melatonin works for you, then adjusting your daily habits can also help with insomnia. In short, melatonin is too mild to help real sleep disorders.”

bedtimetake a cold showermore energetic

Question 1.How to improve insomnia without drugs?

Answer 1.Even patients who are prescribed sleeping pills are also advised to make lifestyle changes to address the source of their insomnia.

Maintaining good sleep hygiene (sleep hygiene) is very important. It does not mean dimming the environment or using fragrances before going to bed, but it needs to be paid attention to when you wake up, such as regular life and rest, not dozing off at work, and not taking a nap , Do not drink coffee after five days, exercise regularly and develop hobbies, etc.

After get off work, remember not to bring work stress home, and avoid overeating, strenuous exercise, and cell phones before going to bed. Singles can read, meditate or do yoga, and those with couples or children can watch TV or chat together, sharing a family relationship.

In addition, many people think that taking a bath before going to bed can help them fall asleep. In fact, a cold bath will lower the body temperature and make people more energetic. For bathing, I would recommend taking a hot shower.

early insomniaGeneral

Question 2.When should I seek medical attention for insomnia?

Answer 2.In fact, if you have insomnia in the early stages, you can seek help from general practitioners or family medicine doctors. They are also familiar with this aspect, and it is not necessary to go directly to a psychiatrist for medical treatment.

If a doctor suspects an underlying psychiatric problem, the patient is referred to a psychiatrist.

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