Mendelson W B, Jain B
Department of Neurology, Cleveland Clinic Foundation, Ohio, USA.
Drug Saf. 1995 Oct;13(4):257-70. doi: 10.2165/00002018-199513040-00005.
Insomnia, the experience of poor quality or quantity of sleep, is a very common complaint. Approximately 65 million adults (36% of the American population) complain of poor sleep, and of this group, 25% have insomnia on a chronic basis. These chronic insomniacs not only report higher rates of difficulty with concentration, memory and the ability to cope with minor irritations but also have 2.5 times more fatigue-related automobile accidents than do good sleepers. Despite its ubiquity, insomnia is often either untreated or inadequately treated. Short-acting hypnotics are advocated for transient insomnia, which lasts less than 3 weeks, and in patients with chronic insomnia as an adjunctive treatment where nonpharmacological treatment is not sufficient to alleviate insomnia and the related daytime detrimental effects. The putative adverse effects of hypnotics must be weighted against the severe health effects caused by continued sleep impairment. If hypnotic agents are used, they should be taken nightly only for brief use, or intermittently in longer term use. Benzodiazepines, zolpidem and zopiclone (in countries where the latter is available) remain the recommended hypnotic agents, although in the past few years there has been much criticism in lay magazines and on television about the use of benzodiazepines. However, this review of the efficacy and tolerability data of the short-acting hypnotics suggests that triazolam is comparable with other short-acting hypnotics at equipotent doses while taking into consideration that for every hypnotic, different study populations display different degrees of efficacy. In addition, contrary to previous suggestions that such adverse effects are rebound insomnia and anterograde amnesia are unique to triazolam, hypnotically equivalent doses of tirazolam have not been shown to produce these effects more frequently than other short-acting hypnotics. The newer nonbenzodiazepine hypnotics seem to be equally efficacious as the short-acting benzodiazepines; whether they will truly have a better adverse effect profile will be determined as more clinical experience accumulates. Despite the availability, relative safety and efficacy of these newer hypnotic agents, they should not be perceived as the sole treatment for insomnia and should be used in conjunction with nonpharmacological techniques (such as adherence to good sleep hygiene, sleep restriction, stimulus control and biofeedback therapy).
失眠，即睡眠质量差或睡眠时间不足的体验，是一种非常常见的主诉。大约6500万成年人（占美国人口的36%）抱怨睡眠不好，在这群人中，25%长期患有失眠症。这些慢性失眠症患者不仅报告在注意力、记忆力和应对轻微刺激能力方面存在更高的困难发生率，而且与睡眠良好者相比，与疲劳相关的汽车事故发生率高出2.5倍。尽管失眠很普遍，但它往往要么未得到治疗，要么治疗不充分。短效催眠药适用于持续时间少于3周的短暂性失眠，以及在慢性失眠患者中作为辅助治疗，当非药物治疗不足以缓解失眠及相关的日间不良影响时使用。必须权衡催眠药的假定不良反应与持续睡眠障碍所造成的严重健康影响。如果使用催眠药，应仅在短期内每晚服用，或在长期使用中间歇服用。苯二氮䓬类药物、唑吡坦和佐匹克隆（在有后者的国家）仍然是推荐的催眠药，尽管在过去几年里，大众杂志和电视上对苯二氮䓬类药物的使用有很多批评。然而，对短效催眠药的疗效和耐受性数据的这项综述表明，在等效剂量下，三唑仑与其他短效催眠药相当，同时要考虑到对于每种催眠药，不同的研究人群表现出不同程度的疗效。此外，与之前认为三唑仑独有的不良反应是反弹性失眠和顺行性遗忘的观点相反，等效催眠剂量的替马西泮并未显示比其他短效催眠药更频繁地产生这些效应。较新推出的非苯二氮䓬类催眠药似乎与短效苯二氮䓬类药物同样有效；随着更多临床经验的积累，它们是否真的会有更好的不良反应谱将得到确定。尽管这些较新的催眠药可用、相对安全且有效，但它们不应被视为失眠的唯一治疗方法，而应与非药物技术（如坚持良好的睡眠卫生、睡眠限制、刺激控制和生物反馈疗法）联合使用。
