《失眠治療趨勢》ppt课件

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1、失眠治療趨勢署立雙和醫院精神科台北醫學大學附設醫院睡眠中心We’velearnedhowtosleep……We’velearnedhownottosleepinsomniaInsomniasymptoms（％）Insomniasyndrome(％）Initial24.65.5Middle15.13.4Terminal14.83.3Non-restorative39.19.3Mixed50.612.0SleeplessinTaiwanLee,Yue-Joe200130kgWhySleepless?WhySleepless?貓熊怎麼睡你知道嗎？馬總統專程CALL動物園長詢問2 /24

2、/2009/台北報導身體疾病導致失眠?PhysicalIllness(10%)精神疾病導致失眠?MentalIllness(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?CircadianDisturbance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?SleepApnea原發性失眠?PrimaryInsomnia(20-25%)猝睡症?Narcolepsy次發性失眠其他原發性睡眠障礙20-25%WhySleepless?NeurophysiologicModelsofInsomniaCircadianSy

3、stemArousalSystemHomeostaticSystemSleepNeuroPhysiologicSystemsHomeostaticRegulationofSleepNeurochemicalbasisofsleephomeostasisAdenosineGeneticcontrolofhomeostaticprocessesSleepduration&responsetosleeplossmaybeaffectedbymutationsofthemurineClockgene.HomeostaticRegulationinInsomniaLoweredhomeo

4、staticsleepdriveReducedEEGslowwaveactivity(Merica&Gaillard,1992)BehavioralfactorsIncreasedrestinginbedSleepingoutsideofthenocturnalsleepperiodReduceddaytimeactivitiesCoffeedrinkingCircadianProcessofSleepTheendogenouspacemakerregulatesthesleep-wakerhythmwithabout24hourpercycle.Humancircadianpe

5、riodisslightlylongerthan24hours.Thecenterofcircadiansystem:Suprachiasmaticnucleus(SCN)Dorsomedialhypothalamus(DHM)BiologicalClockCircadianRegulationinInsomniaExtremecircadiantypeorlessflexiblecircadiansystemasapredisposingfactorforcircadianrhythmsleepdisordersDecreasedmelatoninlevels?Behavio

6、ralFactorsIrregularorchangesofsleep-wakescheduleSleep-induringweekendtocatchuplostsleepChronobiologicalModelsNormalprocessS&CinsleepdeprivationRiemannD,etal.BiologicalPsychiatry.2001;57:67-103.WhySleepless?WhySleepless?WhySleepless?Insomniac’sBrainOnlySleepThen,tofallasleep.NIHSTATE-OF-THE-SC

7、IENCECONFERENCESTATEMENTonChronicInsomniaHistorically,thishasbeentermed“secondaryinsomnia.”…..weproposethattheterm“comorbidinsomnia”maybemoreappropriate.Commoncomorbiditiesincludepsychiatricdisorders,particularlydepressionandsubstanceusedisor