Sateia Michael J, Nowell Peter D
Dartmouth Medical School, Dartmouth-Hitchcock Sleep Disorders Center, Lebanon, NH 03756, USA.
Lancet. 2004;364(9449):1959-73. doi: 10.1016/S0140-6736(04)17480-1.
Effective management of insomnia begins with recognition and adequate assessment. Family doctors and other health care providers such as practice nurses and psychologists should routinely enquire about sleep habits as a component of overall health assessment. Identification and treatment of primary psychiatric disorders, medical conditions, circadian disorders, or specific physiological sleep disorders--eg, sleep apnoea and periodic limb movement disorder--are essential steps in management of insomnia. Conditioned aspects of insomnia can be primary (psychophysiological insomnia) or may complicate sleep disturbance owing to other causes. Approved hypnotic drugs have clearly been shown to improve subjective and objective sleep measures in various short-term situations. Despite widespread use of standard hypnotics and sedating antidepressants for chronic insomnia, their role for this indication still remains to be further defined by research evidence. Non-pharmacological treatments, particularly stimulus control and sleep restriction, are effective for conditioned aspects of insomnia and are associated with durable long-term improvement in sleep.
失眠的有效管理始于识别和充分评估。家庭医生以及其他医疗保健提供者，如执业护士和心理学家，应在全面健康评估中常规询问睡眠习惯。识别并治疗原发性精神障碍、躯体疾病、昼夜节律障碍或特定的生理性睡眠障碍，如睡眠呼吸暂停和周期性肢体运动障碍，是失眠管理的关键步骤。失眠的条件性因素可能是原发性的（心理生理性失眠），也可能因其他原因而使睡眠障碍复杂化。在各种短期情况下，已明确证明批准使用的催眠药物可改善主观和客观睡眠指标。尽管标准催眠药和镇静性抗抑郁药广泛用于慢性失眠，但它们在这一适应症中的作用仍有待研究证据进一步明确。非药物治疗，特别是刺激控制和睡眠限制，对失眠的条件性因素有效，并与睡眠的持久长期改善相关。
