Burman Deepa
Latterman Family Health Center, 2347 Fifth Ave, McKeesport, PA 15132.
FP Essent. 2017 Sep;460:22-28.
Insomnia is the most common type of sleep disorder in the family medicine population. It is defined as a persistent difficulty initiating or maintaining sleep, or a report of nonrestorative sleep, accompanied by related daytime impairment. Insomnia is a significant public health problem because of its high prevalence and management challenges. There is increasing evidence of a strong association between insomnia and various medical and psychiatric comorbidities. Diagnosis of insomnia and treatment planning rely on a thorough sleep history to address contributing and precipitating factors as well as maladaptive behaviors resulting in poor sleep. Using a sleep diary or sleep log is more accurate than patient recall to determine sleep patterns. A sleep study is not routinely indicated for evaluation of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the mainstay of treatment and is a safe and effective approach. The key challenge of CBT-I is the lack of clinicians to implement it. The newer generation nonbenzodiazepines (eg, zolpidem, zaleplon) are used as first-line pharmacotherapy for chronic insomnia. Newer drugs active on targets other than the gamma-aminobutyric acid receptor are now available, but clear treatment guidelines are needed.
失眠是家庭医学人群中最常见的睡眠障碍类型。它被定义为持续存在的入睡困难或维持睡眠困难，或报告睡眠不能恢复精力，并伴有相关的日间功能损害。由于失眠的高患病率和管理挑战，它是一个重大的公共卫生问题。越来越多的证据表明失眠与各种医学和精神共病之间存在密切关联。失眠的诊断和治疗计划依赖于全面的睡眠病史，以解决促成因素和诱发因素以及导致睡眠不佳的适应不良行为。使用睡眠日记或睡眠日志比患者回忆更能准确确定睡眠模式。通常不建议通过睡眠研究来评估失眠。失眠的认知行为疗法（CBT-I）是主要的治疗方法，是一种安全有效的途径。CBT-I的关键挑战在于缺乏实施该疗法的临床医生。新一代非苯二氮䓬类药物（如唑吡坦、扎来普隆）被用作慢性失眠的一线药物治疗。目前已有作用于γ-氨基丁酸受体以外靶点的新型药物，但仍需要明确的治疗指南。
