Also known as "dream analysis", read the signals sent by nightmares
2022-01-12
In the outpatient service, patients often come to see a doctor because of insomnia, and some patients often have nightmares in sleep. Some people will be surprised. Is it a disease to often have nightmares? See a doctor for nightmares? It should be noted that normal dream activity is one of the important factors to ensure the normal vitality of the body, and nightmares are dream experiences that cause extreme anxiety or panic. In addition to psychological background, nightmares may also indicate unhealthy physical and physiological conditions. "Stimulation" is an important cause of dreams Nightmares occur in sleep. Sleep is an essential physiological process to maintain body health. Its importance is second only to breathing and heartbeat. Human normal sleep has two phases, namely "non rapid eye movement sleep (NREM) phase". In NREM phase, most nerve cell activities decrease; "Rapid eye movement sleep (REM) phase", in the REM phase, EEG activity is similar to that during awakening. In normal people's one night sleep, there are 4-6 NREM / REM cycles. Dreams are produced during sleep. During sleep, brain cells enter a resting state, but some brain cells do not rest completely. Weak stimulation will cause their activities and trigger dreams. Dreaming is a normal and essential physiological and psychological phenomenon. Everyone dreams in his sleep every day, but some people remember clearly, others can't remember clearly. The study found that 80% of those who were awakened during rapid eye movement sleep (REM) were dreaming, and only 7% of those who were awakened during non REM sleep (NREM) were dreaming. Normal dream activity is one of the important factors to ensure the normal vitality of the body and a way to coordinate the balance of the human psychological world. Nightmares are dream experiences that cause extreme anxiety or panic. Dreams are various, and their forming factors are very complex. It is generally believed that "stimulation" is an important cause of dreams. These stimuli include: ① External stimuli of the body, such as the rustle of wind blowing leaves, produce a dream of rain; ② The internal stimulation of the body, such as thirst, will dream of looking for water to drink; ③ The continuation of psychological activities during the day, the so-called "thinking every day and dreaming at night"; ④ The memory of the past reappears in our dreams; ⑤ The role of the subconscious. Generally speaking, dreams are based on physical physiology and personal psychology, which are the reflection of objective reality. Nightmares are not only related to psychological background, but also suggest unhealthy physical and physiological conditions. Therefore, nightmares can be a manifestation caused by physiological abnormalities or diseases, such as rapid or slow heart rate, cerebral ischemia and hypoxia, local brain lesions, depression, anxiety and so on; It can also be a disease state or suggest the tendency of some diseases. It can predict some neurodegenerative diseases Some patients often have nightmares and dream of being chased and other terrible dreams, accompanied by shouting, physical and physical activities related to the dream, such as rolling, punching and kicking, and harmful behavior. This is a sleep disorder, which occurs in the phase of rapid eye movement sleep (REM), called rapid eye movement behavior disorder (RBD). RBD is a kind of abnormal sleep characterized by continuous specific dream behavior and rapid eye movement sleep (REM) phase tone relaxation detected in polysomnography (PSG). Specific dream behavior is the core clinical feature of rapid eye movement behavior disorder (RBD), and the detection of rapid eye movement sleep (REM) phase tone relaxation in polysomnography (PSG) is a necessary auxiliary examination for the diagnosis of RBD. However, some PSG can detect rapid eye movement sleep (REM) phase tone relaxation, but there is no clinical manifestation of specific dream behavior, which is more common in patients taking antidepressants. RBD can be divided into primary and secondary. Secondary RBD can be seen in Parkinson's disease, Lewy body dementia, Alzheimer's disease, narcolepsy, tumor, related drugs (especially antidepressants), etc. Primary RBD can predict some neurodegenerative diseases to some extent, especially Parkinson's disease, Lewy body dementia and multisystem atrophy. In 1996, Dr. Carlos h and his team reported that 38% of 29 elderly patients with primary RBD were diagnosed with Parkinson's syndrome within 3.7 ± 1.4 years. This is the beginning of the study on the relationship between RBD and Parkinson's syndrome. Since then, there have been relatively large-scale clinical studies in various countries, which have confirmed that primary RBD indicates that the disease is moving towards this kind of Parkinson's syndrome like disease. The pathological changes of Parkinson's syndrome are mainly the production of Lewy bodies in brain tissue. When Lewy bodies invade the substantia nigra, midbrain and gray matter nucleus of the forebrain, it will lead to Parkinson's like clinical manifestations. However, when Lewy body has not invaded substantia nigra and gray matter nucleus of midbrain and forebrain, and is limited to medulla oblongata or pontine tegmentum, it will not cause Parkinson's like clinical manifestations, but will cause the attack of RBD. This also explains why idiopathic RBD can be used as a predictor of Parkinson's disease. However, an interesting clinical phenomenon is that Parkinson's syndrome will be improved during RBD, which is characterized by more agile, powerful and fluent activities and clearer speech. At present, its mechanism is not clear. Whether because RBD itself may cause physical injury to patients and their co sleepers, or because of its close relationship with Parkinson's syndrome, RBD needs active treatment. In addition to sleeping in separate beds, sleeping in separate rooms and adding guardrails beside the bed, the drugs that can improve the clinical symptoms of RBD are mainly clonazepam and melatonin, but they can not interrupt the progress of the disease. In addition, there are some small-scale clinical studies on levodopa, pramipexole, donepezil and other drugs used in RBD, but the curative effect is not accurate. RBD belongs to "insomnia" in traditional Chinese medicine. The treatment of insomnia in traditional Chinese medicine is supplemented by calming the mind and calming the mind on the basis of tonifying deficiency and reducing excess, adjusting viscera, Qi, Yang and Yin. It is better to reduce excess of the syndrome, such as soothing liver and relieving depression, reducing fire and eliminating phlegm, eliminating guidance and middle; Deficiency syndrome should be supplemented, such as supplementing qi and blood, strengthening spleen, liver and kidney. Over time, Qi and blood consumption and injury can also be transformed into deficiency syndrome. If deficiency and excess are mixed, treatment should be combined with attack and supplement. The use method of calming the mind should be combined with clinical practice, select specific treatment methods such as nourishing blood and calming the mind, calming the heart and calming the mind, and pay attention to psychotherapy, so as to eliminate tension and anxiety and maintain mental comfort. Create a "comfortable sleeping" environment to sleep well So, how can we reduce the occurrence of nightmares in our daily life? First of all, keep a good mood, learn to regulate emotions and release pressure; At the same time, pay attention to the combination of work and rest, work and rest rules, and don't often stay up late. Secondly, reduce the occurrence of nightmares caused by external environmental factors, such as avoiding being too excited before going to bed, watching horror movies, and drinking a lot of alcohol, coffee and strong tea; Comfortable sleeping environment, avoid noisy and smelly sleeping environment, and avoid bad sleeping posture. In addition, reducing possible drug-related effects and active treatment may lead to the primary disease and etiology of nightmares. If you still often have nightmares after physical and mental adjustment, and there are shouting, physical and physical activities in the dream, it is recommended to go to the hospital for treatment. You can intervene with traditional Chinese and Western medicine to reduce symptoms and clarify whether further diagnosis and treatment is needed. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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