新人999失眠多梦如何治疗配图，仅供参考
InsomniaFirst-line treatments for insomnia include improved sleep hygiene,relaxation techniques,paradoxical intention,and cognitive-behavioral therapy. Improved sleep hygiene means the establishment of a disciplined sleep schedule; avoidance of daytime naps; avoidance of caffeine and heavy,spicy,or sugary foods 4-6 hours before bedtime; and engaging in strenuous exercise no later than 2 hours before bedtime. Good sleep hygiene also involves a sleeping environment with comfortable bedding and temperature and noise reduction. Good sleep hygiene also restricts the use of the bed to sleep only. Improved sleep hygiene may also involve a light snack consisting of warm milk or foods high in tryptophan. Studies have shown an increase in slow-wave sleep and in sleep with delta wave EEG patterns for subjects taking tryptophan supplementation.,Relaxation techniques such as yoga,meditation,and autogenic training help reduce anxiety and muscle tension and improve the quality of sleep. Paradoxical intention is a cognitive treatment for insomnia in which the patient focuses on staying awake instead of trying to fall asleep. This activity lowers performance anxiety,sleep effort,sleep-onset latency,and overestimation of the sleep deficit. In cognitive-behavioral therapy,patients learn about productive sleep habits,misconceptions concerning sleep,and the proper expectations of sleep. Cognitive-behavioral therapy is more effective than hypnotic medications in treating insomnia and seems to show sustained and lasting effects after it is discontinued.,Pharmacologic treatment options for insomnia include benzodiazepines,nonbenzodiazepines,opioids,antidepressants,melatonin,melatonin agonists (ramelteon),sedating antihistamines,and atypical antipsychotics. Among the benzodiazepines,hypnotic benzodiazepines that bind the alpha 1 subunit of the GABA(A) receptor provide the most relief of insomnia. These drugs can be used both to help initiate sleep and to increase the length of sleep. However,benzodiazepines have also been shown to promote light sleep and decrease deep sleep. Benzodiazepine use also can cause tolerance and physical dependence. Therefore,benzodiazepines generally are not recommended for use as a long-term treatment for insomnia in most patients.
Nonbenzodiazepines have a lesser effect on the alpha 1 subunit of the GABA(A) receptor; therefore,they are used for mild to moderate forms of insomnia. The risk of dependence on nonbenzodiazepines is lower than the risk of dependence on benzodiazepines.
Opioids are known to decrease REM and stage 2 sleep and are appropriate for patients with pain-associated insomnia.
Tricyclic antidepressants such as amitriptyline and doxepin are strong sedatives and are used as off-label treatments for insomnia. For patients suffering from both depression and insomnia,the antidepressant mirtazapine decreases sleep latency and increases sleep efficiency and sleep time. However,prescribing these drugs warrants careful consideration of their anticholinergic,antihistaminergic,and antiadrenergic side effects. In addition,tricyclic antidepressants can cause withdrawal symptoms and thus rebound insomnia.
Melatonin has been shown to be just as effective as some nonbenzodiazepines both in the initiation of sleep and in the regulation of sleep/wake cycles. Also,melatonin does not alter sleep patterns or affect performance-related skills. Melatonin agonists have proved their efficacy in the treatment of jet lag–induced insomnia and CRDs; however,these agonists have not been as effective in treating other forms of insomnia. Antihistamines such as diphenhydramine and doxylamine are efficacious over-the-counter sedatives. It has been reported that antihistamines are more effective than some prescribed hypnotics. Cyproheptadine has been shown to be superior to benzodiazepines in the promotion of sleep quality.","department":"
