J Fam Pract. 2023 Jul;72(6 Suppl):S31-S36. doi: 10.12788/jfp.0620.
Insomnia is a distinct disorder that is common, yet underrecognized and undertreated in primary care. Treating insomnia has been shown to improve outcomes, including reduced risk of developing cardiovascular and mental health disorders. Insomnia is influenced by the brain's regulation of sleep and wake, which are mutually exclusive events. Insomnia should be treated as a distinct condition, even when occurring with a comorbid diagnosis such as depression or anxiety. Clinicians should implement a multimodal approach to insomnia management, including nonpharmacologic interventions and pharmacologic therapy (when indicated). Pharmacologic agents that are approved by the US Food and Drug Administration for insomnia include benzodiazepine receptor agonists (zolpidem, eszopiclone, and zaleplon), low-dose doxepin (tricyclic antidepressant), ramelteon (melatonin receptor agonist), and dual orexin receptor agonists (DORAs, daridorexant, lemborexant, and suvorexant). Unlike other pharmacologic agents, DORAs inhibit wakefulness rather than induce sedation. Additionally, these medications have no evidence of rebound insomnia or withdrawal, and little to no abuse potential. Daridorexant is the newest DORA, has an ideal half-life of 8 hours, and has demonstrated continued efficacy over a 12-month period. Selection of pharmacologic agent should be based on the patient's comorbid conditions, treatment goals and preferences, and other clinical characteristics.
失眠是一种常见但未被充分认识和治疗的原发性疾病。治疗失眠可以改善预后，包括降低患心血管和心理健康障碍的风险。失眠受大脑调节睡眠和觉醒的影响，这两者是相互排斥的事件。即使失眠与抑郁症或焦虑症等合并诊断同时存在，也应将其视为一种独特的疾病进行治疗。临床医生应采用多模式方法治疗失眠，包括非药物干预和药物治疗（必要时）。美国食品和药物管理局批准用于失眠的药物包括苯二氮䓬受体激动剂（唑吡坦、右佐匹克隆和扎来普隆）、低剂量多塞平（三环类抗抑郁药）、雷美尔酮（褪黑素受体激动剂）和双重食欲素受体激动剂（DORAs，达力雷酮、lemborexant 和 suvorexant）。与其他药物不同，DORAs 抑制觉醒而不是诱导镇静。此外，这些药物没有反弹性失眠或戒断的证据，滥用潜力很小。达力雷酮是最新的 DORA，半衰期为 8 小时，在 12 个月的治疗期间持续有效。药物的选择应基于患者的合并症、治疗目标和偏好以及其他临床特征。
