失眠治疗趋势.ppt

失眠治疗趋势 We’ve learnedhow to sleep…… We’ve learnedhow not to sleep insomniaInsomnia symptoms（％）Insomnia syndrome (％）Initial24.65.5Middle15.13.4Terminal14.83.3Non-restorative39.19.3Mixed50.612.0Sleepless in TaiwanLee, Yue-Joe 2001 30kg Why Sleepless? Why Sleepless?貓熊怎麼睡你知道嗎？馬總統專程CALL動物園長詢問 ?????????????????????/referurl/news/logo/ettoday//SIG=10pugg0rl/*/台北報導 身體疾病導致失眠? Physical Illness (10%)精神疾病導致失眠? Mental Illness (40-50%)使用藥物/物質導致失眠? Substance/Drug (10%)睡醒週期障礙導致失眠? Circadian Disturbance不寧腿症候群或週期性肢體抽動障礙? RLS/PLMD 睡眠呼吸中止症? Sleep Apnea原發性失眠? Primary Insomnia (20-25%)猝睡症? Narcolepsy次發性失眠其他原發性睡眠障礙20-25%Why Sleepless? Neurophysiologic Models of InsomniaCircadian SystemArousal SystemHomeostatic SystemSleepNeuroPhysiologic Systems Homeostatic Regulation of SleepNeurochemical basis of sleep homeostasisAdenosineGenetic control of homeostatic processesSleep duration & response to sleep loss may be affected by mutations of the murine Clock gene. Homeostatic Regulation in InsomniaLowered homeostatic sleep driveReduced EEG slow wave activity (Merica & Gaillard, 1992)Behavioral factorsIncreased resting in bedSleeping outside of the nocturnal sleep periodReduced daytime activitiesCoffee drinking Circadian Process of SleepThe endogenous pacemaker regulates the sleep-wake rhythm with about 24 hour per cycle.Human circadian period is slightly longer than 24 hours.The center of circadian system:Suprachiasmatic nucleus (SCN)Dorsomedial hypothalamus (DHM) Biological Clock Circadian Regulation in InsomniaExtreme circadian type or less flexible circadian system as a predisposing factor for circadian rhythm sleep disordersDecreased melatonin levels?Behavioral FactorsIrregular or changes of sleep-wake scheduleSleep-in during weekend to catch up lost sleep Chronobiological ModelsNormal process S & C in sleep deprivationRiemann D, et al. Biological Psychiatry. 2001;57:67-103. Why Sleepless? Why Sleepless? Why Sleepless?Insomniac’s BrainOnly Sleep Then, to fall asleep. NIH STATE-OF-TH