Department of Psychiatry and Psychotherapy of Freiburg University Medical Center, Freiburg, Germany.
Pharmacopsychiatry. 2011 Jan;44(1):1-14. doi: 10.1055/s-0030-1267978. Epub 2010 Dec 15.
Chronic insomnia afflicts up to 10% of the population in Western industrialized countries. It is characterized by delayed sleep onset, problems in maintaining sleep, early morning awakening or the feeling of non-restorative sleep coupled with significant daytime impairments on an emotional, social or professional level. It can occur as a co-morbid condition in any other medical or mental disorder, but also as a primary condition. Within the last decade new diagnostic and differential diagnostic approaches have been suggested that enhance diagnostic precision. Epidemiological data and data relating to the health care and cost situation of chronic insomnia suggest a huge burden for society. Chronic insomnia leads to a clear-cut increased risk for psychopathology (i. e., affective disorders) and probably also for cardiovascular and metabolic dysfunction. The pathophysiology of the condition is still poorly understood and will profit from integrating modern neuroscientific approaches (animal studies, molecular biology, neuroimaging, neurophysiology, etc.). Current treatment strategies are mainly based on cognitive behavioural interventions (CBT-I) and hypnotic treatment with benzodiazepine receptor agonists and sedating antidepressants. Although the effectiveness of these treatments has been clearly demonstrated, a substantial proportion of patients proves to be treatment-resistant or profits only poorly. The question of long-term pharmaceutical treatment of chronic insomnia, at least in Europe, is unresolved and urgently needs answers. Novel rational treatment avenues require clues on causes and mechanisms from integrated neuroscientific approaches. The important issues concerning insomnia treatment in the future especially in Europe will be reviewed and discussed critically.
慢性失眠困扰着西方工业化国家多达 10%的人口。其特征是入睡延迟、睡眠维持困难、清晨早醒或感觉睡眠质量差，同时伴有明显的日间情绪、社交或职业功能受损。它可以作为任何其他医学或精神障碍的合并症出现，也可以作为原发性疾病出现。在过去十年中，已经提出了新的诊断和鉴别诊断方法，以提高诊断的准确性。慢性失眠的流行病学数据以及与医疗保健和成本状况相关的数据表明，它给社会带来了巨大的负担。慢性失眠会导致明显增加患精神病理学（即情感障碍）的风险，也可能导致心血管和代谢功能障碍。该疾病的病理生理学仍知之甚少，将受益于整合现代神经科学方法（动物研究、分子生物学、神经影像学、神经生理学等）。目前的治疗策略主要基于认知行为干预（CBT-I）和苯二氮䓬受体激动剂和镇静性抗抑郁药的催眠治疗。尽管这些治疗方法的有效性已得到明确证实，但仍有相当一部分患者对治疗无反应或反应不佳。至少在欧洲，关于慢性失眠的长期药物治疗问题尚未解决，急需答案。新型合理的治疗方法需要从综合神经科学方法中寻找病因和发病机制的线索。未来特别是在欧洲，关于失眠治疗的重要问题将被审查和批判性讨论。
