【正文】 mnia: Definition ? Chronic insomnia vs. Acute insomnia – Acute insomnia may occur in anyone at one time or another – Varied definitions for chronic insomnia ? Durations ranging from 30 days – 6 months ? Chronic insomnia is often associated with a wide range of adverse conditions including: – Mood disturbances – Difficulties with concentration and memory – Some cardiovascular, pulmonary, and gastrointestinal disorders NIH Statement. Sleep. 2023。剛開始看精神科時，吃 2顆安眠鎮(zhèn)靜藥物就可以睡上幾個小時，但是總覺得睡不夠，半夜一醒過來就再吃 2顆，有時已經塞了 8顆安眠藥還是睡不好。他聽別人說什麼方法可以治失眠，都會去試，但是效果都不好。慢性失眠及 安眠藥物的使用 財團法人佛教慈濟綜合醫(yī)院精神醫(yī)學部 佛教慈濟大學精神科 林喬祥醫(yī)師 個案描述一 ? 28歲的王先生，唸?？茣r期開始就有經常睡不好，經常得要躺超過一個小時才能入睡，遇到有考試壓力或者和朋友之間有些爭執(zhí)時就更不好睡，就算睡著了，一有聲響很容易就醒過來，又得躺好一陣子才能再入睡。但是他很擔心常用會成癮，總是盡量不用安眠藥，有時一整個星期都沒有一天睡得好。 個案描述二 ? 36歲的陳女士離婚後因為背負卡債及家庭經濟重擔，有入睡困難和睡眠中斷的睡眠障礙已有 5年。 問題討論 ? 問題一： 慢性失眠應用藥物治療治療前應有的評估及處置？ ? 問題二：安眠藥到底是持續(xù)用好還是盡量不要用？ ? 問題三：安眠藥的療效究竟如何？ Insomnia Has Several Definitions NHLBI. Am Fam Physician. 1999。 Katz and McHorney 1998 Chronic Insomnia: Epidemiology Prevalence ? 30% of general population plains of sleep disruption ? 10% has daytime functional impairment Natural History ? Few studies describe the course and duration of insomnia Incidence ? Very little is known about chronic insomnia’ s incidence ? Only a few studies have examined incidence Risk Factors Higher prevalence of insomnia in: ? Women (especially postmenopausal) ? Divorced, separated, widowed adults ? Psychiatric and physical illnesses Other risk factors include cigarette smoking, alcohol, coffee consumption, and numerous prescription drugs NIH Statement. Sleep. 2023。 ?P≤.05. ?P≤.01. CHF = congestive heart failure。22(suppl 2):S379S385. SF36 Subscales* * P Greater Interference Impact of Insomnia in the Workplace ? Daytime functioning and loss of productivity – Two to three times as many days of poor productivity and concentration in individuals with insomnia as in good sleepers ? Absenteeism – Severe insomniacs were absent from work twice as often as good sleepers ? Work accidents – Seven times higher rate of work accidents in insomniacs than in good sleepers Metlaine A, et al. Industrial Health. 2023。 however, the efficacy and safety of pharmacological interventions in the management of chronic insomnia is unclear. ? OBJECTIVE: The objective of this paper is to conduct a systematic review of the efficacy and safety of drug treatments for chronic insomnia in adults. ? DATA SOURCES: Twentyone electronic databases were searched, up to July 2023. ? STUDY SELECTION: Randomized doubleblind, placebocontrolled trials were eligible. Quality was assessed using the Jadad scale. Data were pooled using the random effects model. ? DATA SYNTHESIS: One hundred and five studies were included in the review. Sleep onset latency, as measured by polysomnography, was significantly decreased for benzodiazepines (BDZ), (weighted mean difference: minutes。 95% CI: , 。 95% CI: , ). Indire