【正文】 n g*Scale ranges from 0 to 100, with higher scores reflecting greater quality of life. Adapted from Zammit GK et al. Sleep 1999。 COPD = chronic obstructive pulmonary disease. Katz DA et al. Arch Intern Med. 1998。262:14791484. Percentage * * * * ? ? 1 . 6 1 . 61 . 42 . 20 . 91 . 62 . 51 . 5 1 . 52 . 71 . 81 . 40 . 03 . 0C H F C O P D B a c kp rob l e m sH i pi m p a i rm e n tP e p t i c u l c e r P ros t a t ep rob l e m sM i l d I n s om n i aS e v e re I n s om n i aMedical Conditions Associated With Insomnia *P≤.001。28:10491057. Chronic Insomnia: Consequences ? Some evidence suggests a relationship between chronic insomnia and impaired memory, cognitive functioning, and depressed mood Chronic Insomnia Consequences ? Associated with high health care utilization ? Direct and Indirect Costs: estimated in the tens of billions of dollars annually Quality of Life ?Reduces quality of life ?Hinders social functioning ?Related to impaired work performance NIH Statement. Sleep. 2023。 Hohagen et al. 1993。59 (abstract). Difficulty falling asleep Nextday consequences Difficulty staying asleep Nonrefreshing sleep Early morning awakenings + Given adequate opportunity to sleep Chronic Insomnia: 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。雖然有醫(yī)師建議她應(yīng)該要嘗試其他改善睡眠的方法，並且控制使用安眠藥，但是她就是擔(dān)心不吃睡不著，雖然她也知道其實吃了也不一定睡得好，有時候就乾脆把安眠藥配著啤酒吃，最近喝酒的量也漸漸多起來。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(jīng)塞了 8顆安眠藥還是睡不好。長期下來，白天不但會常頭暈，而且越來越?jīng)]耐性，常常提不起勁來，感覺自己快要垮了，近半年來已經(jīng)把休假請光，還請了不少病假，最近才由朋友介紹到精神科看門診。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。王先生曾經(jīng)在一般開業(yè)醫(yī)師診所處方過安眠藥，效果還不錯。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(xué)部 佛教慈濟大學(xué)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(jīng)常睡不好，經(jīng)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。學(xué)校畢業(yè)後因為家庭經(jīng)濟因素開始工作，睡眠狀況還是不理想。但是他很擔(dān)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。到後來每天一天黑就覺得要找一點上床準(zhǔn)備睡覺，但是又覺得害怕、怕那一天又會睡不好或睡不著 … 。 個案描述二 ? 36歲的陳女士離婚後因為背負(fù)卡債及家庭經(jīng)濟重?fù)?dān)，有入睡困難和睡眠中斷的睡眠障礙已有 5年。後來藥不夠時她就到另一家醫(yī)院的精神科開藥。 問題討論 ? 問題一： 慢性失眠應(yīng)用藥物治療治療前應(yīng)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。28:10491057. Insomnia is the most mon sleep plaint across all stages of adulthood, and for millions, the problem is chronic Insomnia can be a symptom of other disorders, like depression, or it can be a primary disorder in itself The Majority of Insomniacs is Chronically Ill 59835375690102030405060708090 Mild insomnia Severe insomnia Insomnia (DSMIIIR)