Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Center for Sleep Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
Neurotherapeutics. 2021 Jan;18(1):44-52. doi: 10.1007/s13311-021-01010-z. Epub 2021 Feb 1.
Insomnia is a highly prevalent condition associated with significant morbidity, reduction in quality of life, and increase in healthcare costs, and is a risk factor for multiple physical and mental disorders. The primary treatment modality is cognitive behavioral therapy for insomnia (CBT-I) but this is associated with difficulties with access and higher cost as well as poor response in some patients. Therefore, pharmacotherapy for insomnia is common and hypnotic agents are among the most frequently prescribed medications in the United States. Older medications for insomnia are limited by their side effect burden and narrow therapeutic window. Newer hypnotics, on the other hand, have been shown to have a better safety profile and longer term efficacy. While some studies have shown that long-term hypnotic use is associated with adverse outcomes, the current evidence is equivocal. The decision to treat chronic insomnia disorder with long-term hypnotics should be individualized and balance the potential risks of continuing hypnotic medication use with the risks of untreated persistent insomnia and associated functional limitations. This clinical review discusses the currently available medication options to treat insomnia, their mechanisms of action, dosing, and side effect profiles. This review also provides guidance on long-term management of hypnotics and the use of these medications in the elderly, those with medical comorbidities, and other special populations.
失眠是一种高发疾病，与较高的发病率、生活质量下降以及医疗费用增加有关，也是多种身心障碍的风险因素。主要的治疗方式是失眠的认知行为疗法（CBT-I），但这种疗法存在可及性困难、费用较高以及部分患者应答不佳等问题。因此，失眠的药物治疗很常见，催眠药物是美国最常开的药物之一。治疗失眠的传统药物存在副作用负担重和治疗窗窄的问题。相比之下，新型催眠药具有更好的安全性和更长期的疗效。尽管一些研究表明长期使用催眠药与不良后果有关，但目前的证据尚存在争议。是否使用长期催眠药来治疗慢性失眠障碍应根据个体情况而定，需权衡继续使用催眠药的潜在风险与未经治疗的持续性失眠及其相关功能障碍的风险。本文综述了目前可用于治疗失眠的药物选择、作用机制、剂量和副作用特征。本文还为催眠药的长期管理以及在老年人、有合并症的患者和其他特殊人群中使用这些药物提供了指导。
