Paul Soumi, Vidusha Karavadi, Thilagar Sivasudha, Lakshmanan Dinesh Kumar, Ravichandran Guna, Arunachalam Abirami
Department of Environmental Biotechnology, School of Environmental Sciences, Bharathidasan University, Tiruchirappalli, 620024, Tamil Nadu, India.
Department of Community Medicine, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India.
Sleep Med. 2022 Mar;91:124-140. doi: 10.1016/j.sleep.2022.02.018. Epub 2022 Mar 1.
This review is intended to provide an updated summary of, but not limited to, classification, etiopathogenesis, diagnosis, and treatment strategies for insomnia disorder. The severity of insomnia symptoms irrespective of co-existing primary medical condition/s in the studied patients classified insomnia as 'insomnia disorder' to prioritize the clinical attention on insomnia (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). The frequency and duration of symptoms further divided insomnia into chronic, short-term, and other insomnia disorder (International Classification of Sleep Disorders, Third Edition). This disorder is a phenomenal state of hyperarousal developed and perpetuated by environmental, behavioral, cognitive, genetic, socioeconomic, preexisting medical factors. Overarching physiological, cortical, behavioral, and cognition changes in hyperarousal manifest insomnia disorder. It, sometimes, leads to the co-occurrence of other chronic medical condition/s. The contemporary diagnosis of insomnia disorder needs to consider modified diagnostic criteria, growing evidence on insomnia disorder symptoms, associated factors, co-existing medical condition/s (if any) to identify the subjective severity of insomnia disorder and design a treatment plan. The recommended treatment strategies include cognitive-behavioral therapy for insomnia (CBTI) and pharmacotherapy. However, CBTI lacks accessibility, qualified facilitators, and pharmacotherapy has limitations like side effects, physiological tolerance/dependence. The investigation of phytocompounds subdued these drawbacks of existing treatments as some compounds showed anti-insomniac potential. Furthermore, complementary alternative medicines (CAMs) like mindfulness-based practices, acupuncture, listening to music, Yogasanas, Pranayama, digital cognitive behavioral therapy for insomnia (dCBTI) during bedtime proved supportive in insomnia disorder treatment.
本综述旨在提供失眠症分类、病因发病机制、诊断及治疗策略等方面的最新总结，但不限于这些内容。无论所研究患者是否存在原发性疾病，失眠症状的严重程度将失眠归类为“失眠症”，以便临床优先关注失眠问题（《精神疾病诊断与统计手册》第五版）。症状的频率和持续时间进一步将失眠分为慢性、短期和其他失眠症（《国际睡眠障碍分类》第三版）。这种疾病是一种由环境、行为、认知、遗传、社会经济、既往医疗因素所引发并持续存在的过度觉醒状态。过度觉醒中总体的生理、皮层、行为和认知变化表现为失眠症。它有时会导致其他慢性疾病的并发。当代失眠症的诊断需要考虑修订后的诊断标准、关于失眠症症状、相关因素、并存疾病（如有）的越来越多的证据，以确定失眠症的主观严重程度并设计治疗方案。推荐的治疗策略包括失眠认知行为疗法（CBTI）和药物治疗。然而，CBTI缺乏可及性、合格的指导人员，并且药物治疗存在副作用、生理耐受性/依赖性等局限性。植物化合物的研究克服了现有治疗方法的这些缺点，因为一些化合物显示出抗失眠的潜力。此外，一些补充替代医学（CAMs），如正念练习、针灸、听音乐、瑜伽体式、调息法、睡前数字认知行为疗法（dCBTI），在失眠症治疗中被证明是有帮助的。
