失眠
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| 失眠 Insomnia |
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| 影片介紹 | |
| 發音 |
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| 醫學專科 | 精神病學、睡眠醫學 |
| 症狀 | 難以入睡、白天想睡覺、沒精神、應激性、抑鬱[1] |
| 併發症 | 車禍[1] |
| 肇因 | 未知、心理壓力、慢性疼痛、心臟衰竭、甲狀腺功能亢進症、胃灼熱、不寧腿綜合徵[2][3] |
| 診斷方法 | 根據症狀、睡眠檢測[4] |
| 相似疾病或共病 | 睡眠相位後移症候群、不寧腿綜合徵、睡眠呼吸暫停、精神疾病[5]、睡眠障礙 |
| 治療 | 睡眠衛教、認知行為療法、安眠藥[6][7][8] |
| 盛行率 | 0~20%[9][3][10] |
失眠（英語：Insomnia）是一種不容易自然地進入睡眠狀態的症狀[1]。可能是不易入睡（難以入睡），或是很難維持較長時間的深度睡眠（難以維持睡眠）[11][9]。失眠一般會伴隨著白天精神不佳、嗜睡、易怒、或是抑鬱等症狀[1]。失眠可能會增加車禍意外的風險，也可能會讓人注意力不集中、工作易疲憊及學習效果不佳[1]。失眠可能是短期的，持續幾天到一週，也可能是長期的，持續一個月以上[1]。
失眠有可能是受到其他藥物、症狀或疾病的影響，不過也可能無關[2]。會導致失眠的症狀有心理壓力、慢性疼痛、心臟衰竭、甲狀腺功能亢進症、胃灼熱、不寧腿綜合徵、更年期，也有可能是因為咖啡因、尼古丁及酒精的影響[2][3]，其他風險因子有輪班工作制及睡眠呼吸中止症候群[9]。失眠診斷會根據睡眠習慣為基礎，也會進行身體檢查，以確認是否有其他潛藏造成失眠的病症[4]，也可能會進行睡眠檢測來找出失眠的原因[4]。
一般而言，會以睡眠衛教及生活習慣的調整作為第一線的治療方式[6][8]。睡眠衛教包括充足的睡眠時間、白天時曬太陽、安靜及昏暗的臥室以及規律的運動[8]，可以再配合認知行為治療[7][12]。安眠藥可能會有幫助，不過有些受傷、失智症及成癮的症狀和安眠藥使用有關[6][7]。若使用藥物治療，一般不建議使用超過四週到五週[7]。還不清楚替代療法在治療失眠的效果及安全性[6][7]。
在任何特定時間點，人群中均有10%至30%的成年人患有失眠；而至多一半人一年之中均患有失眠症[3][9][10]。約6%患有並非其他原因導致的失眠（原發性失眠），並持續一個月以上[9]比較起來，65歲以上人群更容易患有失眠問題[8]。女性相較男性更易患有失眠問題[3]。在西方世界中，對失眠的記載至少可以追溯到古希臘時期[13]。
類型[編輯]
DSM-5 診斷標準[編輯]
精神疾病診斷與統計手冊第五版（DSM-5）中寫到，失眠的診斷標準如下： [14]
病患主訴中提到對於睡眠時間長度和睡眠品質的不滿與下列至少一項敘述有關：
（兒童失眠的表現通常是需要照顧者的介入否則難以重返睡眠。）
- 太早起床，而且難以再次入睡。
除以上之外，還有以下標準：
- 失眠已經導致臨床上的憂鬱、社會功能損害、職業功能損害、教育、學業、行為及其他領域的困難。
- 每七天會有至少三天晚上出現失眠的困擾。
- 失眠問題已經存在至少三個月。
- 即便有睡覺的機會，仍然失眠。
- 失眠並非由其他的睡眠疾病引起（例如：發作性嗜睡病、與呼吸相關的睡眠障礙-睡眠呼吸中止症、晝夜節律性睡眠障礙、異睡症等）
- 失眠不是因為物質使用所致，比如說：藥物或是物質濫用。
- 失眠並非由其他心理疾病或疾病所引起的。
子類別[編輯]
失眠可分為「短暫型失眠」、「急性失眠」、或「慢性失眠」三種：
- 短暫性失眠通常持續不到一周。短暫性失眠可能是由其他疾病或原因造成的，比如說：睡眠環境改變、睡覺時間改變、時差、嚴重的憂鬱症或壓力。Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation.[15]
- Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function.[16] Acute insomnia is also known as short term insomnia or stress related insomnia.[17]
- Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia.[18] Its effects can vary according to its causes. They might include muscular weariness, hallucinations, and/or mental fatigue. Chronic insomnia can cause double vision.[15]
特徵[編輯]
失眠的症狀:[19]
- 入睡困難, 包括難以找到一個舒服的入眠姿勢
- 夜間醒來且無法再次入眠
- feeling unrefreshed upon waking
- daytime sleepiness, irritability or anxiety
Sleep-onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders. Delayed sleep phase disorder can be misdiagnosed as insomnia, as sleep onset is delayed to much later than normal while awakening spills over into daylight hours.[20]
It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep. Two-thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a middle-of-the-night awakening.[21]
Early morning awakening is an awakening occurring earlier (more than 30 minutes) than desired with an inability to go back to sleep, and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of depression.[22]
睡眠品質不佳[編輯]
Poor sleep quality can occur as a result of, for example, restless legs, sleep apnea or major depression. Poor sleep quality is caused by the individual not reaching stage 3 or delta sleep which has restorative properties.[23]
Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.
Nocturnal polyuria, excessive nighttime urination, can be very disturbing to sleep.[24]
主觀 Subjectivity[編輯]
Some cases of insomnia are not really insomnia in the traditional sense. People experiencing sleep state misperception often sleep for normal durations, yet overestimate the time taken to fall and remain asleep.[25]
參見[編輯]
參考資料[編輯]
- ^ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 What Is Insomnia?. NHLBI. December 13, 2011 [9 August 2016].
- ^ 2.0 2.1 2.2 What Causes Insomnia?. NHLBI. December 13, 2011 [9 August 2016].
- ^ 3.0 3.1 3.2 3.3 3.4 Dyssomnias (PDF). WHO: 7–11. [2009-01-25].
- ^ 4.0 4.1 4.2 How Is Insomnia Diagnosed?. NHLBI. December 13, 2011 [9 August 2016].
- ^ Watson, Nathaniel F.; Vaughn, Bradley V. Clinician's Guide to Sleep Disorders. CRC Press. 2006: 10. ISBN 9780849374494 （英語）.
- ^ 6.0 6.1 6.2 6.3 How Is Insomnia Treated?. NHLBI. December 13, 2011 [9 August 2016].
- ^ 7.0 7.1 7.2 7.3 7.4 Qaseem, A; Kansagara, D; Forciea, MA; Cooke, M; Denberg, TD; Clinical Guidelines Committee of the American College of, Physicians. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians.. Annals of Internal Medicine. 3 May 2016, 165: 125–33. PMID 27136449. doi:10.7326/M15-2175.
- ^ 8.0 8.1 8.2 8.3 Wilson, JF. In the clinic: Insomnia. Annals of Internal Medicine. 1 January 2008, 148 (1): ITC13–1–ITC13–16. PMID 18166757. doi:10.7326/0003-4819-148-1-200801010-01001.
- ^ 9.0 9.1 9.2 9.3 9.4 Roth, T. Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine. 2007, 3 (5 Suppl): S7–10. PMC 1978319. PMID 17824495.
- ^ 10.0 10.1 Tasman, Allan; Kay, Jerald; Lieberman, Jeffrey A.; First, Michael B.; Riba, Michelle. Psychiatry, 2 Volume Set 4. John Wiley & Sons. 2015: 4253. ISBN 9781118753361 （英語）.
- ^ Golub, R. M. Insomnia. JAMA. 2012, 307 (24): 2653–2653. PMID 22735439. doi:10.1001/jama.2012.6219.
- ^ Trauer, James M.; Qian, Mary Y.; Doyle, Joseph S.; W. Rajaratnam, Shantha M.; Cunnington, David. Cognitive Behavioral Therapy for Chronic Insomnia. Annals of Internal Medicine. 9 June 2015, 163: 191–204. PMID 26054060. doi:10.7326/M14-2841.
- ^ Attarian, Hrayr P. Clinical Handbook of Insomnia. Springer Science & Business Media. 2003: Chapter 1. ISBN 9781592596621 （英語）.
- ^ 14.0 14.1 14.2 "Sleep Wake Disorders ." Diagnostic and statistical manual of mental disorders: DSM-5.. 5th ed. Washington, D.C.: American Psychiatric Association, 2013. -. Print.
- ^ 15.0 15.1 Roth, T.; Roehrs, T. Insomnia: Epidemiology, characteristics, and consequences. Clinical Cornerstone. 2003, 5 (3): 5–15. PMID 14626537. doi:10.1016/S1098-3597(03)90031-7.
- ^ Insomnia – sleeplessness, chronic insomnia, acute insomnia, mental .... [2008-04-29]. （原始內容存檔於March 29, 2008）.
- ^ Acute Insomnia – What is Acute Insomnia. Sleepdisorders.about.com. [2013-03-10].
- ^ Simon, Harvey. In-Depth Report: Causes of Chronic Insomnia. New York Times. [4 November 2011].
- ^ Consumer Reports; Drug Effectiveness Review Project. Evaluating New Sleeping Pills Used to Treat: Insomnia Comparing Effectiveness, Safety, and Price (PDF). Best Buy Drugs Consumer Reports (Consumer Reports). January 2012: 4 [4 June 2013].
- ^ Kertesz, R. S.; Cote, K. A. Event-Related Potentials During the Transition to Sleep for Individuals with Sleep-Onset Insomnia. Behavioral Sleep Medicine. 2011, 9 (2): 68–85. PMID 21491230. doi:10.1080/15402002.2011.557989.
- ^ Doghramji, Karl. Clinical Management of Insomnia. Caddo, OK: Professional Communications, Inc. 2007: 28. ISBN 978-1-932610-14-7.
- ^ Morin, Charles. Insomnia: A Clinician's Guide to Assessment and Treatment. New York, New York: Kluwer Academic/Plenum Publishers. 2003: 16. ISBN 0-306-47750-5.
- ^ What Happens When You Sleep?. sleepfoundation.org. [2017-02-24].
- ^ Adler, C. H.; Thorpy, M. J. Sleep issues in Parkinson's disease. Neurology. 2005, 64 (12 Suppl 3): S12–S20. PMID 15994219. doi:10.1212/WNL.64.12_suppl_3.S12.
- ^ Harvey, A. G.; Tang, N. (Mis)Perception of Sleep in Insomnia: A puzzle and a resolution. Psychological Bulletin. 2011, 138 (1): 77–101. PMC 3277880. PMID 21967449. doi:10.1037/a0025730.
參考文獻[編輯]
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