Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA.
J Sleep Res. 2023 Dec;32(6):e14084. doi: 10.1111/jsr.14084. Epub 2023 Nov 8.
This article reviews the history of insomnia pharmacotherapy, documenting the evolution that has occurred over time in the increasing availability of medications with novel mechanisms of action that more specifically target the neural systems that modulate sleep/wake function. This evolution provides an increasing capacity to improve the effectiveness of insomnia pharmacotherapy by allowing the selection of medications that specifically target the particular type of sleep difficulty present in each patient. As a result, they can achieve a therapeutic effect with fewer effects on aspects of brain function other than those needed to achieve benefit, thereby minimising adverse effects. The accumulated evidence-base is such that it can serve as the basis for a personalised insomnia pharmacotherapy paradigm. Here we outline a set of best-practice recommendations for how to carry out optimised personalised insomnia pharmacotherapy based on that evidence base in the hope that it will improve the treatment delivered to the many individuals suffering from insomnia.
本文回顾了失眠药物治疗的历史，记录了随着时间的推移，作用机制新颖的药物不断增加，这些药物更能针对调节睡眠/觉醒功能的神经系统，从而发生了演变。这种演变提供了通过选择专门针对每个患者存在的特定类型睡眠困难的药物来提高失眠药物治疗效果的能力。因此，他们可以在不影响除实现获益所需的大脑功能之外的其他方面的情况下实现治疗效果，从而最大限度地减少不良反应。积累的证据基础足以作为个性化失眠药物治疗模式的基础。在这里，我们根据该证据基础概述了一套最佳实践建议，以开展优化的个性化失眠药物治疗，希望它能改善许多失眠患者的治疗效果。
