Erman Milton K
Department of Psychiatry, University of California at San Diego School of Medicine, San Diego, CA 92121, USA.
J Clin Psychiatry. 2005;66 Suppl 9:18-23; quiz 42-3.
Pharmacologic and nonpharmacologic therapies both have roles in the treatment of insomnia. The benzodiazepines, when first introduced, were a major improvement over earlier treatments for insomnia in terms of their safety and efficacy. Since then, the nonbenzodiazepine benzodiazepine receptor agonists have been developed, which have provided advantages over the older medications and are currently first-line medication treatment for insomnia. Although antidepressants, antipsychotics, and anticonvulsants are often prescribed for the treatment of insomnia, they are not approved by the U.S. Food and Drug Administration for this indication and have side effects that are sometimes severe. New types of medications that have different modes of action from the benzodiazepine receptor agonists are now being developed, and one, a selective melatonin receptor agonist, has recently been approved for treatment of insomnia. Nonpharmacologic therapies can also help patients learn how to fall asleep faster and improve sleep quality. It is important for physicians to teach patients good sleep hygiene as part of their treatment. Cognitive-behavioral therapy is effective in the treatment of insomnia, alone and in combination with pharmacotherapy, but finding a qualified provider can be difficult and the patient must be willing to take the time to learn the therapies and wait for them to show effect.
药物治疗和非药物治疗在失眠症的治疗中都发挥着作用。苯二氮䓬类药物在首次引入时，相较于早期的失眠治疗方法，在安全性和有效性方面有了重大改进。从那时起，非苯二氮䓬类苯二氮䓬受体激动剂被研发出来，它们比旧药物具有优势，目前是失眠症的一线药物治疗。尽管抗抑郁药、抗精神病药和抗惊厥药经常被用于治疗失眠，但它们未被美国食品药品监督管理局批准用于此适应症，且有时会有严重的副作用。目前正在研发与苯二氮䓬受体激动剂作用方式不同的新型药物，其中一种选择性褪黑素受体激动剂最近已被批准用于治疗失眠。非药物治疗也可以帮助患者学会更快入睡并改善睡眠质量。医生将良好的睡眠卫生知识传授给患者作为治疗的一部分很重要。认知行为疗法单独或与药物疗法联合使用对失眠症的治疗有效，但找到合格的治疗提供者可能很困难，而且患者必须愿意花时间学习这些疗法并等待其显示效果。
