Nino-Murcia G
Sleep Medicine and Neuroscience Institute, Palo Alto, Calif. 94303.
J Clin Psychiatry. 1992 Dec;53 Suppl:43-7; discussion 48-9.
Despite the fact that the prevalence rate for insomnia in the United States is high (35.2%), the number of patients with this condition do not represent a large percentage of patients evaluated and treated in sleep disorders clinics. On the other hand, the great majority of patients with insomnia do not seek treatment for their condition from their physicians. Several hypotheses have been created to explain this phenomenon: (1) lack of training for physicians in the area of sleep disorders, (2) pessimism in relation to treatment outcome shared by patients and physicians, and (3) time constraints and other reasons on the part of the physicians. Insomniacs, however, deserve accurate diagnosis and effective treatments for their condition. Insomnia is often the result of multiple factors converging rather than one single cause. For academic purposes, however, different disorders in difficulties with initiation and maintenance of sleep are discussed. Among them, adjustment sleep disorder, obstructive sleep apnea, periodic limb movements in sleep, circadian abnormalities, and psychiatric disturbances. Emphasis is placed on the treatment of each, along with the treatment of the other factors that are commonly found in patients with insomnia: poor sleep hygiene, use of medications that disrupt sleep, performance anxiety, deficient exposure to entrainers of circadian rhythms, diet, and exercise. A comprehensive treatment that includes a multifactorial approach is the ideal way to treat patients with insomnia. Research that will enhance our knowledge of the biological substrate of insomnia will provide clinicians with additional tools to improve the outcome of their treatments of patients with insomnia.
尽管美国失眠症的患病率很高（35.2%），但在睡眠障碍诊所接受评估和治疗的患者中，患有这种疾病的患者数量所占比例并不大。另一方面，绝大多数失眠患者并未向医生寻求针对其病情的治疗。已经提出了几种假设来解释这一现象：（1）医生在睡眠障碍领域缺乏培训；（2）患者和医生对治疗结果都持悲观态度；（3）医生存在时间限制及其他原因。然而，失眠症患者理应得到针对其病情的准确诊断和有效治疗。失眠往往是多种因素共同作用的结果，而非单一原因所致。不过，出于学术目的，我们会讨论在入睡和维持睡眠方面存在困难的不同病症。其中包括适应性睡眠障碍、阻塞性睡眠呼吸暂停、睡眠期周期性肢体运动、昼夜节律异常以及精神障碍。重点在于对每种病症的治疗，以及对失眠患者中常见的其他因素的治疗：不良的睡眠卫生习惯、使用会干扰睡眠的药物、表现焦虑、缺乏对昼夜节律同步器的接触、饮食和运动。采用多因素方法的综合治疗是治疗失眠患者的理想方式。能够增进我们对失眠生物学基础认识的研究，将为临床医生提供更多工具，以改善他们对失眠患者的治疗效果。
