新人999失眠症如何治疗配图，仅供参考
Treatment of InsomniaFirst-line treatment for insomnia is cognitive-behavioural therapy,which should ideally be performed before hypnotics are prescribed. Good sleep hygiene is one component of cognitive-behavioural therapy that is important whatever the cause and is often the only treatment that patients with mild problems need.
Cognitive-behavioural therapy for insomnia focuses on managing common thoughts,worries and behaviours that interfere with sleep (Fig. [(Fig.4)4](https://ncbi.nlm.nih.gov/pmc/articles/PMC7952372/figure/Fig4/) ) .
[](https://ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click on image to zoom&p=PMC3&id=7952372_40292_2021_436_Fig4_HTML.jpg)
[Open in a separate window](https://ncbi.nlm.nih.gov/pmc/articles/PMC7952372/figure/Fig4/?report=objectonly) [Fig. 4.](https://ncbi.nlm.nih.gov/pmc/articles/PMC7952372/figure/Fig4/)
Diagnostic workup and treatment options for insomnia. See text for details. OSA obstructive sleep apnoea,BDZ benzodiazepines,ESS Epworth sleepiness scale,ISI insomnia severity index,DBAS-16 dysfunctional beliefs and attitudes about sleep
General guidelines for the use of hypnotics aim to minimise abuse,misuse and dependence.
All hypnotics (except ramelteon,low doses of doxepin and suvorexant) act on the benzodiazepine recognition site on the γ-aminobutyric receptor (GABA) and increase the inhibitory effects of γ-aminobutyric acid. Melatonin,which in Italy is registered as a drug in its 2 mg prolonged-release formulation and has a specific first-line indication for insomnia in patients over 55 years of age,does not act on GABA receptors .
Hypnotics differ mainly in terms of elimination,half-life and principle of action. Some hypnotics (e.g.,first-generation benzodiazepines) have greater chances of inducing residual sedation in the morning,especially after prolonged use and/or in the elderly,in which they may also increase the risk of falls,episodes of confusion and impaired cognitive performance.
In recent decades,selective hypnoinducers,so-called Z-drugs (such as zolpidem and zopiclone) have been developed,which can theoretically be taken even in conjunction with an infra-hypnic awakening provided that patients have the chance to sleep for at least 4 h after administration.
Hypnotics should be used with caution in patients with respiratory failure. In the elderly,any hypnotic,even at reduced doses,can cause restlessness,psychomotor agitation,or exacerbation of states such as delirium and dementia.
Difficulties can be minimised by using the lowest effective dose for brief periods and gradually reducing the dose before stopping the drug.
It should also be recalled that both European guidelines and an Italian consensus indicate 2 mg prolonged-release melatonin as the first therapeutic choice in insomniac subjects over the age of 55 years for up to 13 weeks . In addition to benzodiazepines and hypno-inducing drugs,there are also many other drugs not specifically indicated for insomnia that are used to induce and maintain sleep. Antihistamines such as doxorubicin and diphenhydramine can induce sleep. However,their efficacy is variable; moreover,these drugs can cause adverse effects such as confusion,urinary retention and possible systemic anticholinergic side effects,which are potentially serious in the elderly.
Antidepressants taken at low doses at bedtime (e.g. 5–20 mg paroxetine,50 mg trazodone,75–200 mg trimipramine) may improve sleep. However,they should be used at low doses mainly when standard hypnotics are not tolerated (rare),or in high doses (antidepressants) when concomitant depression of mood is present.
Melatonin is a hormone that is secreted by the pineal gland (and is found naturally in some foods such as oats,almonds and corn,for example). Darkness stimulates secretion,whereas light inhibits it. By binding melatonin receptors in the suprachiasmatic nucleus,melatonin regulates the circadian rhythm and especially the sleep–wake cycle. Exogenous melatonin supplementation may be indicated in various sleep disturbance conditions: jet lag,fragmented sleep or delayed sleep phase syndrome. Oral melatonin can be administered in different dosages and formulations depending on the condition we are treating (typically from 0.5 to 5 mg before bedtime). The key element is the time of administration,which must be regular and chosen on the basis of the sleep disorder we are dealing with . The choice of the product to be taken is therefore key,since most of the available melatonin products are “over-the-counter” supplements and sometimes the actual dosage of melatonin they contain is not well regulated.
In Italy there is only one product registered as a prolonged-release melatonin-based drug at a dose of 2 mg .
Treatment response can be evaluated with the readministration of questionnaires first collected at baseline for the assessment of insomnia severity (Insomnia Severity Index,ISI ) or sleep related beliefs and attitudes in insomnia (Dysfunctional Beliefs and Attitudes about Sleep short version,DBAS-16 ) (Figs. [(Figs.4,4](https://ncbi.nlm.nih.gov/pmc/articles/PMC7952372/figure/Fig4/),[,55](https://ncbi.nlm.nih.gov/pmc/articles/PMC7952372/figure/Fig5/) ).
[Fig. 5.](https://ncbi.nlm.nih.gov/pmc/articles/PMC7952372/figure/Fig5/)
Common questionnaires for detection and monitoring of insomnia. See text for details","department":"
