失眠的治疗__培训课件.pptVIP

咪唑吡啶类 酒石酸唑吡坦 全球最多选用的非安定类安眠药 收录于美国食品药品管理局目录(FDA) 迅速从肠胃道吸收：Tmax=1.6小时 半衰期短：T1/2=2.5小时 代谢产物无活性 下列人群使用时注意 老年人：剂量减少(Cmax和Tmax增加，但无蓄积作用) 肾功能障碍：无需剂量调整 肝功能障碍：减量使用 选择性作用于?-氨基丁酸/苯二氮卓复合物上的?1受体 ?1受体：催眠作用 ?2受体：肌肉松弛、抗焦虑、抗惊厥作用 ?3受体：作用至今不明，估计与肌肉松弛作用相关 使?-氨基丁酸受体对?-氨基丁酸位点A的亲和力得到增强 来自脑的兴奋性冲动得以抑制 导入睡眠 无次日残余效应 无记忆功能影响 无失眠反跳现象 无耐受现象 与中枢抑制药物合用时有可能的相加作用 副反应少见 * 而长期失眠也使精神疾病的发生危险性更高，研究发现，失眠的患者中抑郁症的发生率远远高于无失眠人，达4倍之多。 * 抑郁症是一种精神疾病，抑郁患者得临床表现大多存在入睡困难与夜间多次觉醒，这些失眠症状可能更加重抑郁，使治疗更为困难。 * Various medications that the patient may be taking for other disorders as well as substances like nicotine, alcohol and caffeine can cause insomnia.1-3 Certain over-the-counter products may also cause insomnia.1-3 Elderly patients may be particularly prone to drug-induced insomnia. Not only do many of them take numerous prescription and nonprescription medications, but because of their lighter sleep, older patients may be more susceptible to the effects of medications that act on the CNS. KEY POINTS Various medications can disrupt sleep. Elderly patients are at greater risk for drug-induced insomnia due to more frequent use of medications and greater susceptibility to CNS-active medications, compared with younger patients. 1. Ashton H. The effects of drugs on sleep. In: Cooper R, ed. Sleep. London: Chapman Hall Medical; 1994:175-211. 2. Becker PM, Jamieson AO, Brown WD. Insomnia. Use of a ‘decision tree’ to assess and treat. Postgrad Med. 1993;93:66-85. 3. Brunton SA. When your patient can’t sleep. Family Practice Recertification. 1992;14:149-168. * Certain lifestyle activities constitute poor sleep hygiene. Keeping irregular times for sleeping and waking, exercising too late at night or not at all, and routinely using caffeine, nicotine, and/or alcohol before bedtime can each result in insomnia. Educating patients about the importance of good sleep hygiene, including the sleep hygiene measures listed in this slide, is a basic component of treating insomnia.1,2 KEY POINTS Insomnia can be caused by ce