Balogh A
Institut für Klinische Pharmakologie der Friedrich-Schiller-Universität Jena.
Z Arztl Fortbild Qualitatssich. 2001 Jan;95(1):11-6.
For the treatment of insomnia/sleep disturbances, drugs are indicated only if non-drug-procedures alone are not sufficiently successful or not successful at all. To facilitate sleep, sedative-hypnotic agents are used clinically. Because of favorable risk-benefit ratio, non-benzodiazepines with benzodiazepine-like action (zolpidem, zopiclon) or benzodiazepines themselves (dependent on their pharmacokinetic profil) are administered in the most cases. Sedative-hypnotic drugs reducing the electric activity of the CNS sufficiently to produce coma and even death are not recommended at present. To assess the clinical relevance of amino acid L-tryptophan for the treatment of insomnia/sleep disturbances, more controlled clinical studies are necessary. The nonprescription antihistamines (Doxylamin, Diphenhydramin) are only suitable for short-term administration in adults. Under certain conditions, antidepressant and antipsychotic drugs can be taken. Because of potential risks, the intake demands caution. Different herbal remedies are recommended, but only for extracts of valerian a sleep-inducing effect can be assumed. Melatonin, an endogenous hormone and tryptophan-metabolite is thought to be involved with the sleep-wake cycle. Therefore the exogenous intake of melatonin may influence vigilance and sleep. This is particularly true for patients with jet-lag symptoms.
对于失眠/睡眠障碍的治疗,仅在非药物治疗方法单独使用效果不佳或完全无效时才考虑使用药物。为促进睡眠,临床上会使用镇静催眠药。由于风险效益比良好,多数情况下会使用具有苯二氮䓬样作用的非苯二氮䓬类药物(唑吡坦、佐匹克隆)或苯二氮䓬类药物本身(取决于其药代动力学特征)。目前不推荐使用能充分降低中枢神经系统电活动从而导致昏迷甚至死亡的镇静催眠药物。为评估氨基酸L-色氨酸对治疗失眠/睡眠障碍的临床相关性,还需要更多对照临床研究。非处方抗组胺药(多西拉敏、苯海拉明)仅适用于成人短期使用。在某些情况下,可以服用抗抑郁药和抗精神病药。由于存在潜在风险,服用时需谨慎。推荐使用不同的草药疗法,但只有缬草提取物被认为具有助眠作用。褪黑素是一种内源性激素和色氨酸代谢产物,被认为与睡眠-觉醒周期有关。因此,外源性摄入褪黑素可能会影响警觉性和睡眠。这在有飞行时差症状的患者中尤为明显。