Pal Arghya, Joshi Tanmay, Basu Aniruddha, Gupta Ravi
Department of Psychiatry, All India Institute of Medical Sciences, Raibareli, 229405 India.
Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, 249203 India.
Sleep Vigil. 2022;6(1):51-60. doi: 10.1007/s41782-022-00197-1. Epub 2022 Mar 17.
Insomnia is a highly prevalent disorder that is seen across all age groups causing significant morbidity to the patients. Its prevalence has further risen during COVID-19 pandemic. It is widely acknowledged that untreated insomnia can lead to significant health risks and socio-occupational dysfunction.
A narrative review was conducted following focused search of databases.
Available guidelines mention two different approaches for the management of insomnia-pharmacological and non-pharmacological. Non-pharmacological therapies like multicomponent cognitive behavior therapy for insomnia (CBT-I) have been advocated for the management of acute as well as chronic insomnia in the literature as it has been found efficacious and useful. Multiple variants of CBT-I, e.g., digitally delivered CBT-I, brief CBT-I have been tested during pandemic owing to closure of clinics. However, there are certain issues to be considered while choosing CBT-I as therapy. For example, like other forms of psychotherapies, is there a need for assessing the candidature of patient before administering CBT-I; is CBT-I free of adverse effects as commonly thought; is CBT-I more efficacious than hypnotics; and at last, how to manage cases that are not candidate for CBT-I.
This narrative review addresses the scientific robustness of evidence for issues related to adherence, efficacy and adverse effects of non-pharmacological therapies. Available literature suggests that data related to adherence and efficacy of CBT-I suffer from methodological shortcomings and careful selection of patient is important for the successful therapy. At the same time, attempts have been made to shed light to the areas where CBT-I can be helpful in the management of insomnia.
失眠是一种高度普遍的疾病，在所有年龄组中都有出现，给患者带来了严重的发病问题。在新冠疫情期间，其患病率进一步上升。人们普遍认识到，未经治疗的失眠会导致重大的健康风险和社会职业功能障碍。
在对数据库进行重点检索后进行了叙述性综述。
现有指南提到了两种不同的失眠管理方法——药物治疗和非药物治疗。文献中提倡采用多成分失眠认知行为疗法（CBT-I）等非药物疗法来管理急性和慢性失眠，因为它已被证明是有效且有用的。由于诊所关闭，在疫情期间对CBT-I的多种变体，如数字交付的CBT-I、简短CBT-I进行了测试。然而，在选择CBT-I作为治疗方法时，有一些问题需要考虑。例如，与其他形式的心理治疗一样，在实施CBT-I之前是否需要评估患者的候选资格；CBT-I是否像通常认为的那样没有不良反应；CBT-I是否比催眠药更有效；最后，如何管理不适合CBT-I的病例。
本叙述性综述探讨了与非药物疗法的依从性、疗效和不良反应相关问题的证据的科学稳健性。现有文献表明，与CBT-I的依从性和疗效相关的数据存在方法学缺陷，谨慎选择患者对成功治疗很重要。同时，已尝试阐明CBT-I在失眠管理中可能有帮助的领域。
