失眠之最新概況 - tma.tw

1 / * * nonrestorative sleep (1) 30-40% 10-15% (2) 2010 (Sleep) 6 65 6 8 12% (3) (National Sleep Foundation) 46% 25% (4) ( ) ( ) ( ) 4 41% (5) ( The International Classification of Sleep Disorders, 2nd Edition) ICSD-2 (sleep disorder) ( i n s o m n i a ) ( s l e e p related breathing disorders) (hypersomnias of central origin) - (circadian rhythm sleep disorders) (parasomnias) (sleep related movement disorders) (isolated symptoms and normal variants) (other sleep disorders) (6) (DSM-IV) (1) ICSD-2 (insomnia) ICSD-2 ( )

2 (psychophysiological insomnia) 31031182011, , (inadequate sleep hygiene) (insomnia due to medical condition) 1 (insomnia due to mental disorder) (insomnia due to drug or substance) ( ) 2 (circadian rhythm) 1986 Spielman P (predisposing factor) (precipitating factor) (perpetuating factor) ( )(7) 1 (6) 2 (6) ( l a m o t r i g i n e [ L a m i c t a l ] , p h e n y t o i n [Dilantin]) (methylphenidate [Ritalin]) (selective serotoninreuptake inhibitors, bupropion [Wellbutrin])) (atoravastatin [Lipitor]) (levodopa) (< 30 ) ( ) ( ) (> 30 ) ( ) ( ) ( )

3 - (circadian rhythm disorder)( ) ( )31031192011, , ( ) (hyperarousal system) (homeostatic system) (circadian system) delta delta (8) (physiological) ( c o g n i t i v e ) ( c o r t i c a l ) 1 9 9 3 Morin (9) Morin (dysfunctional beliefs and attitudes about sleep questionnaire, DBAS DBAS-16 ) 1997 Perlis (10) ACTH cortisol beta positron emission tomography, PET (11) ( 1 2) ( ) ( ) ( ) ( ) ( ) (advanced sleep phase syndrome) (delayed sleep phase syndrome)

4 ( ) ( DBAS-16 ) (12) ( 1) P i t t s b u r g h S l e e p Q u a l i t y Index(PSQI) 3(13) Insomnia Questionnaire( ) ( 4) ( ) (polysomnography, PSG) (actigraphy) (multiple sleep latency test, MSLT) 312313102011, , 3 (13) 1. 2. 3. 4. 5 6 7 8 0 1 2 3 5. (1) 30 ____ (2) ____ (3) ____ (4) ____ (5) ____ (6) ____ (7) ____ (8) ____ (9) ____ (10) ( ) ____ 6.

5 ( ) ____ 7. ____ 8. ____ 9. ____ 4 (19) Time 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 1/1E XXXXXXX CS+1/21/3 XXXX ++++ C ( ) A ( ) M ( ) ( ) E S ( / ) 1~5( ~ ) 1~5( ~ ) 1/1 Stilnox-10 ___3___ ___2___ (sleep apnea syndrome) (narcolepsy)

6 ( p e r i o d i c l i m b m o v e m e n t disorder) MSLT (6) 312313112011, , benzodiazepine ( B Z D ) n o n - B Z D o f f l a b e l u s e ( ) ( ) B Z D n o n - B Z D ( s l e e p l a t e n c y ) BZD triazolam temazepam non-BZD zaleplon zolpidem eszopiclone (waking after sleep onset) BZD non-BZD (rebound insomnia) (6) ( 4 ) ( ) 2 0 0 5 Roth eszopiclone e s z o p i c l o n e 2007 Walsh eszopiclone (14) 2002 Estivill 41% (15) (as-needed use) (nightly) 2008 Krystal 3-7 Zolpidem CR (16) a m i t r i p t y l i n e d o x e p i n trazodone mirtazapine t r a z o d o n e t r a z o d o n e (6) trazodone 1 b l o c k e r ( p r i a p i s m )

7 Doxepin amitriptyline mirtazapine r a m e l t e o n 2 0 0 9 Mayer ramelteon (17) 2008 Journal of Clinical Sleep Medicine (6) ( ) BZD non-BZD ramelteon ( z o l p i d e m eszopiclone) BZD trazodone mirtazapine amitriptyline B Z D non-BZD gabapentin tiagabine q u e t i a p i n e o l a n z a p i n e diphendydramine 314315122011, , (valerian extract) ( s t i m u l u s c o n t r o l i n s t r u c t i o n s ) ( s l e e p r e s t r i c t i o n therapy) (relaxation trainings) (biofeedback) (cognitive therapy) (light therapy) 1994 Morin 5 (11) Backhaus 2001 Archives of psychiatry (18) 7 0 - 8 0 % (sleep hygiene) 11 ( ) ( )

8 20 30 ( ) (stimulus control therapy) 20 (sleep restrict therapy) (relaxation trainings) (progressive muscle relaxation) (19) - (circadian rhythm sleep disorders) (phase advance) (sleep latency) (phase delay) (lux) 10 lux 8000lux 5000lux 2500lux 10000lux 30 ( ) ( 30 ) ( 2 ) 314315132011, , (20) (bio-psycho-social) 1.

9 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders-Text Revision, 4th ed, Washington (DC), American Psychiatric Publishing Inc, Roth T: New developments for treating sleep disorders. J Clin Psychiatry 2001; 62 Cappuccio FP, D Elia L, Strazzullo P, et al.: Sleep duration and all-cause mortality: a systematic review and meta-analysis of pro spective studies. Sleep 2010;33 Gallup Organization: Sleep in America. Princeton, Gallup Organization, NJ; 1991. 5. Doghramji PP: Recognizing sleep disorders in a primary care setting. J Clin Psychiatry 2004;65 Schutte-Rodin S, Broch L, Buysse D, et al.: Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008; 15 Spielman AJ, Caruso LS, Glovinsky PB: A behavioral perspective on insomnia treatment.

10 Psychiatr Clin North Am 1987;10 Perlis ML, Smith MT, Pigeon WR: Etiology and pathophysiology of insomnia. In: Kryger M, Roth T, Dement WC, editors. Principle and Practice of Sleep Medicine. Philadelphia, PA:Elsevier Saunders; 2005; Morin CM: Insomnia: psychological assessment and management. New York, Guilford Press, Perlis ML, Giles DE, Mendelson WB, et al.: Psychophysiological insomnia: the behavioural model and a neurocognitive perspective. J Sleep Res 1997;6 Morin CM, Culbert JP, Schwartz SM: Non-pharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 1994;151: 2007 13. Buysee DJ, Reynolds CF, Monk TH, et al.: The Pi