Costa e Silva Jorge Alberto
The International Center for Mental Health Policy and Research, New York University-School of Medicine, New York NY, USA.
Metabolism. 2006 Oct;55(10 Suppl 2):S40-4. doi: 10.1016/j.metabol.2006.07.012.
Sleep is an active state that is critical for our physical, mental, and emotional well-being. Sleep is also important for optimal cognitive functioning, and sleep disruption results in functional impairment. Insomnia is the most common sleep disorder in psychiatry. At any given time, 50% of adults are affected with 1 or more sleep problems such as difficulty in falling or staying asleep, in staying awake, or in adhering to a consistent sleep/wake schedule. Narcolepsy affects as many individuals as does multiple sclerosis or Parkinson disease. Sleep problems are especially prevalent in schizophrenia, depression, and other mental illnesses, and every year, sleep disorders, sleep deprivation, and sleepiness add billions to the national health care bill in industrialized countries. Although psychiatrists often treat patients with insomnia secondary to depression, most patients discuss their insomnia with general care physicians, making it important to provide this group with clear guidelines for the diagnosis and management of insomnia. Once the specific medical, behavioral, or psychiatric causes of the sleep problem have been identified, appropriate treatment can be undertaken. Chronic insomnia has multiple causes arising from medical disorders, psychiatric disorders, primary sleep disorders, circadian rhythm disorders, social or therapeutic use of drugs, or maladaptive behaviors. The emerging concepts of sleep neurophysiology are consistent with the cholinergic-aminergic imbalance hypothesis of mood disorders, which proposes that depression is associated with an increased ratio of central cholinergic to aminergic neurotransmission. The characteristic sleep abnormalities of depression may reflect a relative predominance of cholinergic activity. Antidepressant medications presumably reduce rapid eye movement (REM) sleep either by their anticholinergic properties or by enhancing aminergic neurotransmission. Intense and prolonged dreams often accompany abrupt withdrawal from antidepressant drugs, a reflection of an REM rebound after drug-induced REM deprivation. The postulated link between sleep and psychiatric disorders has been reinforced by the findings of modern neurobiology.
睡眠是一种活跃状态，对我们的身心健康至关重要。睡眠对于最佳认知功能也很重要，睡眠中断会导致功能受损。失眠是精神病学中最常见的睡眠障碍。在任何给定时间，50%的成年人受到一种或多种睡眠问题的影响，如入睡困难、难以保持睡眠、难以保持清醒或难以遵循一致的睡眠/清醒时间表。发作性睡病影响的人数与多发性硬化症或帕金森病相当。睡眠问题在精神分裂症、抑郁症和其他精神疾病中尤为普遍，每年，睡眠障碍、睡眠剥夺和嗜睡在工业化国家的国家医疗保健账单中增加数十亿美元。尽管精神科医生经常治疗继发于抑郁症的失眠患者，但大多数患者会与普通医生讨论他们的失眠问题，因此为这一群体提供明确的失眠诊断和管理指南很重要。一旦确定了睡眠问题的具体医学、行为或精神原因，就可以进行适当的治疗。慢性失眠有多种原因，包括医学疾病、精神疾病、原发性睡眠障碍、昼夜节律障碍、药物的社会或治疗用途或适应不良行为。睡眠神经生理学的新兴概念与情绪障碍的胆碱能 - 胺能失衡假说一致，该假说提出抑郁症与中枢胆碱能与胺能神经传递的比例增加有关。抑郁症的特征性睡眠异常可能反映了胆碱能活动的相对优势。抗抑郁药物可能通过其抗胆碱能特性或增强胺能神经传递来减少快速眼动（REM）睡眠。突然停用抗抑郁药物通常会伴有强烈而持久的梦境，这是药物诱导的REM剥夺后REM反弹的反映。现代神经生物学的研究结果强化了睡眠与精神疾病之间的假定联系。
