Pagel J F
Department of Family Practice, University of Colorado Medical School, Rocky Mountain Sleep Disorders Center, Pueblo, Colorado, USA.
Dent Clin North Am. 2001 Oct;45(4):855-65.
Each person spends one third of his or her life asleep. It is not surprising that such a complex and pervasive cognitive state should be affected by drugs in many different ways. A philosophy that remains cogent for the CNS is that new research almost always shows this system to be more complex than previously thought. Only a few years ago, if patients complained of difficulty sleeping, they were given pills, often dangerous and addictive pills, to induce sleep no matter what the basis of the complaint might be. Sleeping pills may be safer now, and the understanding of the sleep state itself has increased rapidly. Diagnoses are still diffuse, however, and treatments are often poorly directed. Depression is the offspring of the phlegmatic disposition and the melancholia of another era. Clinically, diagnosis is based on a global assessment of symptoms. It is likely that a diagnosis of depression may include a spectrum of underlying diseases that cannot now be clinically differentiated. Medications have multiple effects on sleep and have many side effects. Progress has, however, been made beyond mother's little pills. Insomnia is no longer a diagnosis but a complaint to be addressed--a symptom of 1 of 60 potential sleep disorders. Each of these disorders has specific and appropriate treatments.
每个人一生中有三分之一的时间在睡眠中度过。如此复杂且普遍存在的认知状态会受到药物多种不同方式的影响，这并不奇怪。对于中枢神经系统而言，一个仍然有说服力的观点是，新的研究几乎总是表明这个系统比之前认为的更加复杂。就在几年前，如果患者抱怨睡眠困难，无论其抱怨的根源是什么，他们都会被给予药物，通常是危险且易上瘾的药物来诱导睡眠。现在安眠药可能更安全了，而且对睡眠状态本身的理解也迅速增加。然而，诊断仍然不明确，治疗往往针对性不强。抑郁症是另一个时代黏液质气质和忧郁症的产物。临床上，诊断基于对症状的全面评估。抑郁症的诊断可能涵盖一系列目前无法通过临床加以区分的潜在疾病。药物对睡眠有多种作用且有许多副作用。然而，已经取得了超越母亲的小药丸的进展。失眠不再是一种诊断，而是一个需要解决的主诉——是60种潜在睡眠障碍之一的症状。这些障碍中的每一种都有特定且合适的治疗方法。
