Walsh James K
Sleep Medicine and Research Center, St. John's Mercy and St. Luke's Hospitals, Department of Psychiatry, Saint Louis University, St. Louis, MO, USA.
J Clin Psychiatry. 2004;65 Suppl 16:41-5.
Pharmacotherapy is indicated for many types of insomnia, most notably transient insomnia associated with stress, acute illness, or jet lag. Many patients with chronic insomnia, including primary insomnia and insomnia secondary to a variety of medical and psychiatric disorders, also benefit from pharmacotherapy. Relatively few individuals receive prescription medication to help them sleep, and the majority use medication for a few nights to several weeks, as opposed to continuous use for months or years. The hypnotics available on the U.S. market today are benzodiazepine receptor agonists (BZRAs). The BZRAs are efficacious in reducing sleep latency, increasing total sleep time, reducing awakenings, and improving sleep quality without the development of tolerance in studies as long as 6 months. Side effects of the BZRAs are infrequent, dose-related, and related to the sedative properties of the drug. Sedating antidepressants are also frequently prescribed to promote sleep despite inadequate data to support their efficacy for this indication and a greater potential for clinically troublesome side effects.
药物治疗适用于多种类型的失眠，最显著的是与压力、急性疾病或时差相关的短暂性失眠。许多慢性失眠患者，包括原发性失眠以及继发于各种医学和精神疾病的失眠，也能从药物治疗中获益。相对较少的人接受处方药物来帮助睡眠，而且大多数人用药几个晚上到几周，而不是连续使用数月或数年。目前美国市场上可用的催眠药是苯二氮䓬受体激动剂（BZRAs）。在长达6个月的研究中，BZRAs在减少入睡潜伏期、增加总睡眠时间、减少觉醒和改善睡眠质量方面有效，且不会产生耐受性。BZRAs的副作用不常见，与剂量有关，且与药物的镇静特性有关。尽管缺乏足够的数据支持其在这一适应症上的疗效，且临床上出现麻烦副作用的可能性更大，但镇静性抗抑郁药也经常被开处方用于促进睡眠。
