Management of insomnia: update and new approaches.
Management of insomnia: update and new approaches.
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DOI：
10.2147/nss.s6642
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发表时间：
2010
影响因子：
3.4
通讯作者：
Riemann D
中科院分区：
文献类型：
--
作者：
Unbehaun T;Spiegelhalder K;Hirscher V;Riemann D
失眠是全世界最普遍的睡眠障碍。许多研究评估了药理学和非药理学治疗方法的疗效。为了在慢性失眠的治疗中获得长期效果，认知行为疗法(CBT-I)是治疗失眠的首选疗法，包括睡眠和睡眠卫生教育、睡眠限制、刺激控制、放松技术和对抗夜间反省的认知策略。短期效果很容易通过使用催眠药来实现。获得所有类型的治疗仍然被认为是一个问题，特别是CBT-I似乎只在专门中心提供，而不是在普通医疗保健中。为了向可能寻求帮助或尚未进入卫生保健系统的病人提供适当的护理，提供治疗的新方法似乎是必要的。基于互联网的治疗选择和分级护理模式可能是未来可行的选择。否则，除了对每个失眠患者的生活质量和日间功能受损的个人影响之外，与失眠有关的直接和间接成本可能会进一步增加。此外，成熟的心理和药物治疗选择，针灸等替代治疗可能构成新的非药物治疗可能性。需要随机对照研究来评估这种方法和其他治疗失眠的新方法的疗效。
Insomnia is the most prevalent sleep disorder worldwide. A number of studies evaluated the efficacy of pharmacological and nonpharmacological treatment approaches. To obtain long-term effects in the management of chronic insomnia, cognitive-behavioral therapy for insomnia (CBT-I) is the treatment of first choice, encompassing education about sleep and sleep hygiene, sleep restriction, stimulus control, relaxation techniques, and cognitive strategies to combat nocturnal ruminations. Short-term effects can easily be achieved by the administration of hypnotic drugs. Gaining access to all types of treatment can still be considered a problem, especially CBT-I seems to be available only at specialized centers but not in general health care. New approaches to treatment delivery seem to be necessary to provide adequate care for patients who may seek help or have not entered the health care system yet. Internet-based treatment options and stepped-care models might be feasible options for the future. Otherwise, the direct and indirect costs associated with insomnia might further increase for our societies, in addition to the personal impact on aspects of quality of life and impaired daytime functioning for each individual with insomnia. Besides, well-established psychological and pharmacological treatment options, alternative treatments like acupuncture might constitute new nonpharmacological possibilities. Randomized controlled studies are needed to evaluate the efficacy of this and other new approaches to treat insomnia.