Sleep Disorder Management During Weight Loss: From Diagnosis to Non-pharmacological Intervention

I. Overview Insomnia is a sleep disorder characterized by frequent and persistent difficulty falling asleep and/or maintaining sleep, accompanied by subjective dissatisfaction. In short, it's about not being able to fall asleep, waking up early, and not sleeping well. Insomnia is directly related to obesity, functional gastrointestinal disorders, diabetes, and hypertension, and can also trigger mental illnesses such as anxiety and depression. Patients with persistent and untreated insomnia have a 2-10 times higher chance of developing or relapsing into depression. Insomnia seriously damages patients' physical and mental health, affects their quality of life, and impacts work efficiency. II. Classification and Diagnosis Clinically, insomnia is subtyped into difficulty falling asleep, difficulty maintaining sleep, early awakening, or a combination of these three types. The severity of clinical symptoms as self-reported by the patient is often used as a reference in the Insomnia Severity Index (ISI) scale. Insomnia is closely linked to depression and anxiety. According to the International Sleep Disorders Standards of Sleep Disorders (ICSD-3), the diagnostic criteria for chronic insomnia include: difficulty falling asleep, difficulty maintaining sleep, or early awakening; the presence of daytime symptoms such as fatigue, decreased attention, and impaired social functioning; and these symptoms occurring at least 3 times per week for at least 3 months. The diagnostic criteria for short-term insomnia are similar to those for chronic insomnia, but the duration of the illness is less than 3 months. III. Causes: For overweight or obese patients, appropriate weight loss can alleviate sleep apnea syndrome, improve oxygenation, improve metabolism, and relieve stress, thereby effectively improving sleep. Studies have found that with weight loss and reduction in abdominal fat, sleep quality improves by an average of about 20%. However, inappropriate weight loss methods may lead to or even worsen insomnia. For example, some weight-loss drugs contain amphetamines or caffeine, which can cause excessive central nervous system excitation and difficulty falling asleep. In addition, extreme dieting-related nutritional imbalances leading to hypoglycemia and hyperthyroidism can also cause insomnia. Anxiety and depression caused by excessive psychological burden in the pursuit of weight loss also affect sleep. IV. Prevention and Treatment Measures

Lifestyle adjustments: (1) Diet and nutrition: Do not eat dinner too late or too much; avoid stimulating foods such as alcohol, coffee, tea, and spicy foods; choose some sleep-aiding foods for dinner or before bed, such as milk, yogurt, walnuts, apples, and bananas; supplement calcium, magnesium, and B vitamins appropriately; do not drink too much water before bed; avoid taking medications that affect sleep and weight-loss drugs containing caffeine. (2) Sleep and daily routine adjustments: Do not stay up late or stay up late less often. At the same time, avoid excessive fatigue or excessive excitement before bed, and spend half an hour in quiet before going to bed. Have at least half an hour of physical exercise during the day. Optimize the sleep environment, such as room temperature, noise, and light.

Psychotherapy: 80% of insomnia is caused by psychological factors. The long-term efficacy of cognitive behavioral therapy for insomnia is better than that of drug therapy. (1) Cognitive therapy: Correcting misconceptions about sleep, trying to maintain a regular sleep schedule, and not doing things unrelated to sleep in bed. (2) Sleep restriction: Appropriately shortening nighttime sleep time and improving sleep efficiency. (3) Pre-sleep relaxation: Using music therapy or hypnotherapy to reduce sympathetic nerve excitability, or trying a hot bath, hot foot bath, breathing exercises, or yoga before bed. (4) Light therapy: Influencing the suprachiasmatic nucleus of the hypothalamus, which controls the circadian rhythm, through light stimulation.

Hospital visits and medication: If lifestyle adjustments and psychological counseling are ineffective, medication should be administered promptly. FDA-approved sleep medications include benzodiazepines and non-benzodiazepines. Most of these medications are classified as psychotropic and must be taken under the guidance of a specialist physician.

Traditional Chinese Medicine (TCM) Treatment: TCM treatment also has its unique aspects. Commonly used methods include herbal foot baths, acupoint application, acupuncture and massage (common acupoints include Shenmen, Neiguan, and Sanyinjiao); commonly used prescriptions include Suanzaoren Tang and Jiaotai Wan. It is recommended to consult a TCM specialist hospital for diagnosis and treatment.

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