失眠症的中医证候分析与中药治疗概况

失眠症是指持续相当长时间的对睡眠的质和量不满意的状况,可引起精神无法集中、思考能力减退、警觉力与判断力下降、免疫功能低下、内分泌紊乱等,还与感冒、抑郁症、糖尿病、肥胖、中风、心脏病和癌症的发生有关。现代社会,随着生活水平的提高,体力劳动减少,脑力劳动增加,工作及精神压力日益加重,很多失眠患者情志不畅的表现尤为突出。经过临床观察,我们发现五脏气机失调在失眠症的辨证论治中占有主导作用,因此对失眠及失眠症的研究与治疗就成为重要课题。     

浅谈赵敏教授治疗失眠的经验

随着当今经济社会的快速发展,失眠的发病率正在不断升高,已严重威胁人类生活质量及身体健康。目前临床西医治疗失眠症虽然疗效明显,但副作用及不良反应亦非常突出。中医药治疗失眠较西医显著的优点是不会成瘾,也不会产生依赖性,故失眠患者多选用中医中药进行辨证治疗[1]。赵敏教授总结多年的临床经验,认为失眠脏腑病位以心和肝出现频次最多,且与脾肾有关。失眠证候病机虚和实出现频次对半,因此对失眠进行辨证,尤其要注意心肝并重、虚实并重,具体辨证多责之于痰火扰神、心脾气血虚、肝郁气滞、阴虚火旺、肝火炽盛和心肾不交,则临床上多以补虚泻实,调整脏腑阴阳为治疗原则,同时配合外治法,效果显著。     

酒石酸唑吡坦对非器质性失眠症患者Actigraphy检测指标的影响

目的:应用Actigraphy仪检测酒石酸唑吡坦对非器质性失眠患者睡眠质量的影响。方法:选择非器质性失眠症患者36例,实验第二晚给予10 mg酒石酸唑吡坦,实验第一晚和第四晚采用Actigraph仪监测,观察用药后Actigraph指标的变化。同时设置正常对照组24名,进行基础Actigraph监测。结果:失眠组患者服用酒石酸唑吡坦后,夜间Actigraphy检测显示实际觉醒时间(AWT)、睡眠潜入期(SL)、平均每次觉醒时间(MWB T)与服药前相比,显著缩短(P0.01);睡眠效率(SE)、平均静息状态时长(MLI)与服药前相比,显著提高(P0.01),同时反映身体活动的参数平均活动分数(MAS)和睡眠总体破碎程度的割裂指数(FI)与对照组相比,显著降低(P0.05)。结论:酒石酸唑吡坦能明显改善非器质性失眠患者睡眠,在非器质性失眠症的诊断治疗中Actigraphy仪是一种有效、便捷的方法。     

睡前饮酒会加重失眠

一项研究表明,为了追求睡个好觉,失眠症患者们花在酒精饮品上的钱数远远超过他们在安眠药花费上的总和。然而专家们却说,如果你真的睡不着,喝到酒瓶见底应该是最后不得已的选择。酒精不能帮助入睡,恰恰相反,它实际上会加重失眠症状。     

补肾填精法对脑卒中失眠症模型大鼠血清褪黑素含量表达的影响

目的:探讨补肾填精法对脑卒中失眠症模型大鼠血清褪黑素(Melatonin,MT)含量表达的影响。方法:24只建模成功的脑卒中失眠症大鼠随机平分为3组-模型组、低剂量组、高剂量组。于造模第7 d起,三组分别给予生理盐水及补肾填精汤(低剂量组最终含生药浓度低剂量为0.7 g/mL、中剂量为1.4 g/mL)以1 mL/(100 g·d)灌胃,连续14 d,记录血清MT表达变化情况。结果:三组治疗第1 d、第7 d与第14 d的逃避潜伏期在组内与组间对比差异无统计学意义(P>0.05)。低剂量组、高剂量组治疗第7 d与第14 d的进入中央区次数多于模型组(P<0.05),也多于治疗第1 d(P<0.05),高剂量组也多于低剂量组(P<0.05)。低剂量组、高剂量组治疗第14 d的血清MT含量、去甲肾上腺素转运蛋白与褪黑素受体蛋白相对表达水平高于模型组(P<0.05),高剂量组高于低剂量组(P<0.05)。结论:补肾填精法在脑卒中失眠症模型大鼠中的应用能促进血清MT的释放,提高去甲肾上腺素转运蛋白与褪黑素受体蛋白的表达,从而促进缓解失眠症状。     

放松疗法对高龄老年失眠患者的有效性研究

目的:评价放松疗法对75岁以上老年人失眠状况的有效性。方法:收集90名75岁以上失眠症老年患者病例,随机分配到干预组(n=45)和对照组(n=45),采取随机对照的单盲临床试验。评测工具为匹兹堡睡眠指数量表(Pittsburgh Sleep Quality Index,PSQI)、焦虑自评量表(Self-rating Anxiety Scale,SAS)、老年抑郁量表(Geriatric Depression Scale,GDS)和幸福度量表(Memorial University of Newfoundland scale of happiness,MUNSH)。采用重复测量的方差分析评定干预疗效。结果:与对照组相比,干预组在PSQI总分(P0.001)、SAS(P=0.022)、和GDS(P=0.001)上有统计学意义的显著优势。结论:我们的研究表明,放松疗法对缓解75岁以上老年人的失眠情况有显著疗效。     

失眠症患者脑电超慢涨落图特征研究

目的:探讨失眠症患者的脑电超慢涨落图特征.方法:选择30例失眠症(Insomnia)患者,30例健康体检者作为对照组,在治疗前及常规治疗2月后,运用脑电超慢涨落图(Encephalofluctuograph,EFG)分析技术检测脑内6种神经递质的值.结果:治疗前,脑内神经递质Ach、5-HT、DA、GABA值均低于对照组,两组间比较差异有统计学意义(P＜0.01),而NE、Glu值高于对照组,两组间比较差异均统计学意义(P＜0.01).治疗2月后,失眠症组患者脑内神经递质Ach、5-HT、DA、GABA值较治疗前增加(P＜0.01),而神经递质NE、Glu值较治疗前降低(P＜0.01).结论:脑内神经递质改变极不平衡是失眠症的重要病因,脑电超慢涨落图检测可作为失眠症诊断和疗效判断的依据之一,并对治疗有指导意义.     

酸枣仁汤辅助治疗有助于改善失眠患者的睡眠质量

为了探究酸枣仁汤对治疗失眠的药理作用,本研究将96例失眠症患者根据随机数字表分为两组,其中对照组予以艾司唑仑片治疗,观察组予以艾司唑仑片+酸枣仁汤(suanzaoren decoction,SD)治疗。对比两组治疗前后的疗效及患者匹兹堡睡眠质量指数量表(pittsburgh sleep quality index,PSQI)得分、IL-1α、IL-1ra、IL-1β水平变化,发现观察组有效率高于对照组。两组治疗后的睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能得分较治疗前降低,观察组较对照组降低明显(p0.05)。两组治疗前的IL-1α、IL-1ra、IL-1β水平差异无统计学意义(p0.05);治疗后的IL-1ra、IL-1β水平较治疗前提高,IL-1ra水平较治疗前降低,且观察组比对照组变化明显(p0.05)。研究表明酸枣仁汤可改善患者睡眠质量,是治疗失眠症的有效药物。     

复方安神精油吸入给药的镇静催眠作用及化学成分的GC-MS分析

为研究复方安神精油吸入给药的镇静催眠作用,本实验采用动物自主活动测试和戊巴比妥钠诱导的睡眠潜伏期与睡眠时间实验:GC-MS分析复方安神精油的挥发性化学成分与入脑的主要化学成分;基于网络药理学预测和筛选出治疗失眠症相关靶蛋白与活性成分,旨在为复方安神精油治疗与改善失眠症提供理论依据。研究发现,复方安神精油具有镇静催眠作用,可显著减少动物自主活动,缩短睡眠潜伏期,延长睡眠时间;复方安神精油主要化学成分与入脑主要化学成分中含有多种具有神经中枢镇静催眠作用以及抗焦虑、抗抑郁作用的化学成分;基于网络药理学预测和筛选出25个治疗失眠症相关活性成分作用于39个治疗失眠症相关作用靶点,体现复方安神精油多成分、多靶点发挥镇静催眠作用的特点。     

脑电治疗在帕金森病伴失眠症患者中的应用疗效观察

目的观察脑电治疗帕金森病伴失眠症患者的疗效。方法将我院神经内科收治的68例帕金森病伴失眠症的患者随机分为对照组和干预组各34例,对照组仅给予药物治疗,干预组在药物治疗基础上加用脑电治疗,观察两组患者治疗4周后的匹兹堡睡眠质量指数(PSQI)评分的变化情况,并采用帕金森病综合评分表(UPDRS)为量化指标评估两组患者治疗前后的临床效果。结果干预组的匹兹堡睡眠质量指数(PSQI)显著低于对照组,两组比较差异有统计学意义(P0.05)。治疗4周后,两组患者的UPDRS评分均较治疗前下降(P0.05),而干预组的评分下降较为显著,与对照比较差异有统计学意义(P0.05)。结论脑电治疗能有效改善帕金森病患者的失眠症状,而且能显著缓解帕金森病肌强直症状,安全性高,值得临床推广应用。     

Reducing Dysfunctional Beliefs about Sleep Does Not Significantly Improve Insomnia in Cognitive Behavioral Therapy

The present study examined to examine whether improvement of insomnia is mediated by a reduction in sleep-related dysfunctional beliefs through cognitive behavioral therapy for insomnia. In total, 64 patients with chronic insomnia received cognitive behavioral therapy for insomnia consisting of 6 biweekly individual treatment sessions of 50 minutes in length. Participants were asked to complete the Athens Insomnia Scale and the Dysfunctional Beliefs and Attitudes about Sleep scale both at the baseline and at the end of treatment. The results showed that although cognitive behavioral therapy for insomnia greatly reduced individuals’ scores on both scales, the decrease in dysfunctional beliefs and attitudes about sleep with treatment did not seem to mediate improvement in insomnia. The findings suggest that sleep-related dysfunctional beliefs endorsed by patients with chronic insomnia may be attenuated by cognitive behavioral therapy for insomnia, but changes in such beliefs are not likely to play a crucial role in reducing the severity of insomnia.     

The assessment and management of insomnia: an update

Insomnia poses significant challenges to public health. It is a common condition associated with marked impairment in function and quality of life, psychiatric and physical morbidity, and accidents. As such, it is important that effective treatment is provided in clinical practice. To this end, this paper reviews critical aspects of the assessment of insomnia and the available treatment options. These options include both non‐medication treatments, most notably cognitive behavioral therapy for insomnia, and a variety of pharmacologic therapies such as benzodiazepines, “z‐drugs”, melatonin receptor agonists, selective histamine H1 antagonists, orexin antagonists, antidepressants, antipsychotics, anticonvulsants, and non‐selective antihistamines. A review of the available research indicates that rigorous double‐blind, randomized, controlled trials are lacking for some of the most commonly administered insomnia therapies. However, there are an array of interventions which have been demonstrated to have therapeutic effects in insomnia in trials with the above features, and whose risk/benefit profiles have been well characterized. These interventions can form the basis for systematic, evidence‐based treatment of insomnia in clinical practice. We review this evidence base and highlight areas where more studies are needed, with the aim of providing a resource for improving the clinical management of the many patients with insomnia.     

Primary Menopausal Insomnia: Definition,Review, and Practical Approach

ObjectiveTo present a case of primary menopausal insomnia with hot flashes to introduce recent changes in technology and nomenclature of sleep medicine and to review presentation, diagnosis, and therapies for menopausal insomnia.MethodsClinical findings and results of sleep evaluation in the menopausal study patient are presented with details about polysomnography performed before and after therapy with pregabalin.ResultsA 56.5-year-old female athlete with severe hot flashes and insomnia of 12 years duration was treated with pregabalin, which ameliorated the hot flashes and sweats and improved sleep quality and architecture. Menopause is associated with hormonal and metabolic changes that disrupt sleep. Disruption of sleep can in turn lead to morbidity and metabolic sequelae. Hormonal treatment, although effective, carries risks unacceptable to many patients and physicians. To date, nonhormonal therapies of symptomatic menopause have not been objectively studied for effects on sleep efficiency and architecture. Primary menopausal insomnia is insomnia associated with menopause and not attributable to secondary causes. Polysomnographically, it seems characterized by a high percentage of slow-wave (N3) sleep, decreased rapid eye movement sleep, cyclic alternating pattern, and arousals.ConclusionsPrimary menopausal insomnia is probably mediated through a mechanism separate from hot flashes, and one can occur without the other. Thermal dysregulation and sleep abnormalities of menopause are probably related to more general changes mediated through loss of estrogenic effects on neuronal modulation of energy metabolism, and more clinical direction is expected as this research field develops. Identification of sleep disorders in menopausal women is important, and polysomnographic evaluation is underused in both clinical and research evaluations of metabolic disturbances. (Endocr Pract. 2011; 17:122-131)     

The heritability of insomnia: A meta-analysis of twin studies

Twin studies of insomnia exhibit heterogeneity in estimates of heritability. This heterogeneity is likely because of sex differences, age of the sample, the reporter and the definition of insomnia. The aim of the present study was to systematically search the literature for twin studies investigating insomnia disorder and insomnia symptoms and to meta-analyse the estimates of heritability derived from these studies to generate an overall estimate of heritability. We further examined whether heritability was moderated by sex, age, reporter and insomnia symptom. A systematic literature search of five online databases was completed on 24 January 2020. Two authors independently screened 5644 abstracts, and 160 complete papers for the inclusion criteria of twin studies from the general population reporting heritability statistics on insomnia or insomnia symptoms, written in English, reporting data from independent studies. We ultimately included 12 papers in the meta-analysis. The meta-analysis focussed on twin intra-class correlations for monozygotic and dizygotic twins. Based on these intra-class correlations, the meta-analytic estimate of heritability was estimated at 40%. Moderator analyses showed stronger heritability in females than males; and for parent-reported insomnia symptoms compared with self-reported insomnia symptoms. There were no other significant moderator effects, although this is likely because of the small number of studies that were comparable across levels of the moderators. Our meta-analysis provides a robust estimate of the heritability of insomnia, which can inform future research aiming to uncover molecular genetic factors involved in insomnia vulnerability.     

基于数据挖掘技术的耳穴压豆治疗失眠的选穴规律研究

摘要 目的：运用数据挖掘技术探讨耳穴压豆治疗失眠的选穴规律,为失眠的辨证论治提供新思路。方法：计算机检索中国知网、维普、万方数据库关于耳穴压豆或耳穴压豆结合其它干预措施治疗失眠的临床研究文献,筛选符合纳入标准的文献,建立Excel表格对耳穴压豆信息进行提取,对耳穴的证型、使用频次、耳穴组合和相关性等方面进行挖掘和可视化分析。结果：筛选出耳穴压豆治疗失眠相关文献1232篇,耳穴共86个。失眠辨证分型以虚症为主,其中以心脾两虚为主要证型,其次为心肾不交。耳穴压豆治疗失眠频次最高的穴位依次为神门(96.27%)、心(78.90%)、皮质下(73.70%)、交感(57.22%)、肾(42.69%)、内分泌(32.55%)。耳穴压豆的关联规则结果显示,治疗失眠关联度最高的为神门与心,配伍以神门-心-皮质下最为常见,其中核心耳穴组合为神门、心、皮质下和交感。结论：在研究方法上,引入Cytosccape软件和R语言作为工具,拓宽了耳穴处方的数据挖掘思路;通过数据挖掘分析揭示了耳穴压豆治疗失眠的取穴特点、用穴规律和穴位配伍组合,为临床优化耳穴处方、提高疗效提供指导和启示。     

Determinants of insomnia in relatively healthy elderly. A literature review

A review is presented based on the findings resulting from interview and questionnaire research concerning factors that determine insomnia in relatively healthy elderly. The investigated factors include modes of living, sleep wishes and personality aspects. During the period 1988-1997 18 published reports were found. Based on the findings it is difficult to claim that elderly persons with insomnia are characterized by inappropriate modes of living. There were, however, some (inconsistent) indications that tea consumption, smoking and lack of exercise predicted insomnia. There were also scarce indications for less realistic sleep expectations in bad than in good sleepers. More bad sleepers perceived their sleep as uncontrollable and unpredictable than than good sleepers. Bad sleepers had significantly higher scores for anxiety, neuroticism and depression than good sleepers. Anxiety as well as depression correlated positively with insomnia and negatively with sleep duration. Depression, anxiety or neuroticism often were better predictors of insomnia than health indicators such as perceived health and number of prescribed drugs. The findings suggest that insomnia in relatively healthy elderly is more tightly associated with psychological factors than with modes of living or health indicators. This has some consequences for therapy. In addition to advice concerning modes of living and sleep hygiene, one has to be alert for the possible presence of depression or anxiety. In that case depression or anxiety has to be treated, pharmacologically or nonpharmacologically.     

Variations in circadian genes and individual nocturnal symptoms of insomnia. The HUNT study

Insomnia is a condition characterized by three nocturnal symptoms: problems with sleep onset or maintenance and early morning awakenings (terminal insomnia). Affected individuals may present one or more of these symptoms. Several studies have shown that insomnia is moderately heritable and that proxy phenotypes for the three insomnia symptoms show different heritabilities. This suggests that different nocturnal symptoms of insomnia may arise from different genetic and biological backgrounds. Circadian genes are good candidates to account for these differences as they regulate the periodicity of several physiological functions including sleep. Evidence from studies in animals and humans have suggested that circadian genes might be involved in sleep disturbances such as insomnia. In this study, we investigated the association between Single Nucleotide Polymorphisms (SNPs) in circadian genes and individual symptoms of insomnia and their combinations using data from the Nord-Trøndelag Health Study 3 (the HUNT3 study, N = 50807). Participants (N = 6029) provided information about sleep onset insomnia, maintenance insomnia, and terminal insomnia. Participants who responded “several times a week” to at least one question regarding the mentioned symptoms were classified as cases (N = 3577) and categorized in seven subgroups according to possible symptom combinations. Controls (N = 2452) answered “Never/Seldom” to all sleep-related questions. Using multinomial regression, we assessed 73 SNPs in nine circadian genes (PER1, 2, 3, CRY1, 2, TIMELESS, CLOCK, REV-ERBα, ARNTL) for differences among symptoms subgroups. Twenty-five SNPs showed significant p-values and supportive odds-ratios. All significant SNPs in PER3 were associated with reporting all three symptoms simultaneously. SNPs in CRY genes were associated with terminal insomnia alone or in combination with other symptoms. Genes PER1 and two were mostly associated with sleep maintenance insomnia. However, none of the SNPs remained significant after False Discovery Rate (FDR) correction for multiple statistical testing. In conclusion, even though none of the SNPs remained significant after FDR correction, the clustering of some genes around specific symptoms points to the need for additional research on these relationships.     

The impact of insomnia and sleep disturbances on depression and suicidality.

Previous research has demonstrated an association between suicidality and sleep, suggesting that sleep disturbances may exacerbate mood dysregulation in participants suffering from mood disorders. The purpose of this study was to investigate the impact of sleep disturbances and insomnia on depression and suicidality in a nontreatment seeking sample of college students. Results indicated that insomnia and nightmares were significant predictors of symptoms of depression, while only nightmares significantly predicted suicidal ideation. Further analysis indicated that participants with elevated scores on insomnia, nightmares, or both experienced differing levels of depression and suicidal ideation. Future directions and treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is daily routine important for sleep? An investigation of social rhythms in a clinical insomnia population

Social rhythms, also known as daily routines (e.g. exercise, of school or work, recreation, social activities), have been identified as potential time cues to help to regulate the biological clock. Past research has shown links between regularity and healthy sleep. This study examined the regularity and frequency of daytime activities in a clinical insomnia population and a good sleeper comparison group. Participants (N?=?69) prospectively monitored their sleep and daily activities for a 2-week period. Although participants with insomnia and good sleepers had similar levels of activity, relative to good sleepers, those with insomnia were less regular in their activities. Findings from this study add to the growing number of studies that highlight the relative importance of the regularity of daytime activities on sleep. Accordingly, future research should test treatment components that focus on regulating daytime activities, which would likely improve treatment outcomes.