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HANDBOOK OF PSYCHIATRIC DRUGS - PART 7

Mất ngủ là một vấn đề chăm sóc sức khỏe đáng kể. Các chi phí trực tiếp và gián tiếp của chứng mất ngủ là rất to lớn cho toàn bộ thế giới công nghiệp. Ước tính tỷ lệ nhiễm khác nhau 10-50% dân số trưởng thành, tùy thuộc vào thời gian, chẩn đoán, và các tiêu chí mức độ sử dụng. | 5 SEDATIVE-HYPNOTIC AGENTS INTRODUCTION Insomnia is a significant health care problem. The direct and indirect costs of insomnia are enormous for the entire industrialized world. Estimates of prevalence vary from 10 to 50 of the adult population depending on the diagnostic duration and severity criteria used. An aging population hectic work and personal lifestyles and an increase in the frequency of nontraditional work hours e.g. shift work all may play a role. Older adults women and patients with underlying psychiatric disorders such as schizophrenia anxiety and mood disorders are particularly prone to sleep difficulties. Treatment of the underlying psychiatric illness often improves sleep obviating the need for hypnotics. However some of the very medications used to control the condition could cause insomnia as well. For example SSRIs may induce insomnia while effectively treating an underlying depression. Diagnosis Normal sleep consists of alternating episodes of rapid eye movement REM sleep and non-REM sleep. Non-REM sleep is further divided to 4 stages stage 1 a brief transition between Handbook of Psychiatric Drugs Jeffrey A. Lieberman and Allan Tasman 2006 John Wiley Sons Ltd. ISBN 0-470-02821-1 156 handbook of psychiatric drugs wakefulness and sleep stage 2 accounting for most of the time in non-REM sleep features spindles and K-complexes on the EEG stages 3 and 4 also called delta sleep characterized by high amplitude slow delta waves on EEG is thought to correspond to restorative sleep . Sleep latency typically prolonged in insomnia refers to the time it takes to fall asleep once in bed. In general terms insomnia refers to the real or perceived inability to sleep and presents as difficulty initiating and or maintaining sleep. Primary insomnia is diagnosed in the absence of any other sleep disorder e.g. narcolepsy obstructive sleep apnea or those due to medical conditions or to medication or substance use. To formally make a diagnosis of primary insomnia .