Dement W, Seidel W, Carskadon M
Psychopharmacology Suppl. 1984;1:11-43. doi: 10.1007/978-3-642-69659-6_2.
Most people attribute a restorative function to sleep. This is because experimental or clinical sleep disturbance is usually followed by annoying symptoms of fatigue and sleepiness the following day. Can these daytime changes be documented objectively? In the past several years, the Multiple Sleep Latency Test (MSLT) has been developed and validated as an objective quantitative measure of sleepiness. Multiple assessments of sleep latency yield a profile of sleepiness across the day. This profile changes in the predicted direction with acute total and partial sleep deprivation, chronic sleep deprivation, sleep satiation, and in comparisons between hypersomnia patients and controls. Sleep and wakefulness are complementary phases in the daily cycle of human existence. Adequacy of sleep and energetic wakefulness next day are interacting phases in this cycle. Insomnia can be seen as a perception of disturbed sleep with daytime consequences, but is essentially also a symptom. This paper reviews a number of issues in the diagnosis and treatment of insomnia. The dimensions, daytime consequences and longitudinal aspects of insomnia are considered. Most investigations to date have been geared towards the problem of chronic insomnia and yet we are all likely to suffer from transient insomnia at some point. Psychiatric and psychophysiological disorders have been shown to be the most frequent causes of disorders of initiating and maintaining sleep. Moreover, there is an apparent disparity between subjective and objective sleep parameters with, for example, objectively disturbed sleep in noncomplaining subjects. The criteria of hypnotic efficacy and the effects of triazolam and flurazepam on sleep and daytime alertness have been investigated in normals, chronic insomniacs and the elderly. In general, chronic insomniacs showed all degrees of daytime alertness regardless of nocturnal sleep parameters. About one-third could be classified as fully alert all day long in spite of their complaints. The effect of flurazepam and triazolam on sleep (improvement) was essentially the same. Daytime effects were most closely related to half-life. The long-acting benzodiazepine, flurazepam, impaired daytime alertness although nocturnal sleep was improved. Triazolam improved not only nighttime sleep but also daytime alertness.
大多数人认为睡眠具有恢复功能。这是因为实验性或临床性睡眠障碍通常会在次日引发令人烦恼的疲劳和困倦症状。这些日间变化能否被客观记录下来呢？在过去几年里，多次睡眠潜伏期试验（MSLT）已被开发并验证为一种客观量化嗜睡程度的方法。对睡眠潜伏期进行多次评估可得出一整天的嗜睡情况概况。在急性完全和部分睡眠剥夺、慢性睡眠剥夺、睡眠饱和状态下，以及在发作性睡病患者与对照组的比较中，这一概况会按预期方向发生变化。睡眠和清醒是人类日常生存周期中的互补阶段。充足的睡眠和次日精力充沛的清醒状态是这个周期中相互作用的阶段。失眠可被视为一种对睡眠受干扰及其日间后果的感知，但本质上它也是一种症状。本文综述了失眠诊断和治疗中的一些问题。文中考虑了失眠的维度、日间后果及纵向情况。迄今为止，大多数研究都围绕慢性失眠问题展开，然而我们所有人在某些时候都可能会遭受短暂性失眠。精神疾病和心理生理障碍已被证明是引发和维持睡眠障碍的最常见原因。此外，主观和客观睡眠参数之间存在明显差异，例如，在没有抱怨的受试者中存在客观的睡眠障碍。已在正常人、慢性失眠患者和老年人中研究了催眠药的疗效标准以及三唑仑和氟西泮对睡眠和日间警觉性的影响。总体而言，慢性失眠患者无论夜间睡眠参数如何，都表现出不同程度的日间警觉性。尽管他们有所抱怨，但约三分之一的患者一整天都可被归类为完全警觉。氟西泮和三唑仑对睡眠的影响（改善）基本相同。日间影响与半衰期关系最为密切。长效苯二氮䓬类药物氟西泮虽改善了夜间睡眠，但损害了日间警觉性。三唑仑不仅改善了夜间睡眠，还提高了日间警觉性。
