Author: Chen Chuxiong, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
Review: Sun Yat-sen Memorial Hospital, Sun Yat-sen University
Insomnia is the most common type of sleep disorder in the clinic, and according to epidemiological surveys, up to 10 to 15% of adults meet the diagnostic criteria for insomnia. With the increase of age, the human gland function decreases, melatonin secretion is also reduced accordingly, on average every 10 years decreased by 10% to 15%, which is the main reason why people's sleep time decreases with age, and the prevalence of insomnia gradually increases with age.
In modern society, there are more and more insomnia in young people, which has a lot to do with the rapid pace of life and work and huge life pressure, and is also closely related to the bad living habits and disordered work and rest rules of young people. Of course, insomnia is also closely related to family history, gender, genetic factors, personality characteristics and the ability of individuals to bear stress, once the trigger factors of life stress events appear, it can cause the occurrence of acute insomnia, such as can not be treated and treated in time, can lead to chronic insomnia (symptoms greater than 3 months), it is more difficult to deal with.
Insomnia, whether to take sleeping pills in the end, this is a problem that many people are struggling with. If you don't eat, you may have to endure the pain of insomnia and go to work the next day; if you take the drug for a long time, there may be dependence, once the drug is stopped, there will be withdrawal symptoms, which may also lead to cognitive impairment, body resistance and so on.
In fact, sleeping pills, like most other drugs, have both therapeutic effects and limitations, and need to be viewed dialectically and used scientifically. Guidelines recommend that hypnotic drugs may be given as appropriate on the basis of psychotherapy, but should be individualized, on-demand, intermittent, adequate, and periodically evaluated. If long-term medication is required, it is necessary to formulate an alternative plan for discontinuation under the guidance of a specialist, and it is not possible to prescribe the drug yourself.
So, what are the medications to treat insomnia? What are the features? The following Yixian Pharmacist is introduced to you.
1. Benzodiazepine sleeping pills: representative drugs: diazepam, escolam, alprazolam, clonazepam.
Although such drugs have withdrawal symptoms, psychological dependence, drug tolerance, cognitive impairment, sexual dysfunction and other adverse reactions, such drugs are still clinically irreplaceable, because in addition to the sedative effect, such drugs also have anxiolytic effects, and are recommended by major guidelines at home and abroad in improving insomnia symptoms.
For anxiety insomnia, psychological stress insomnia, traumatic insomnia and other short-term use of such sleeping pills is safe, not easy to produce dependence, but if insomnia is not dealt with in time, once turned to chronic insomnia, it is much trickier to treat.
In benzodiazepines sleeping drugs, the sedative effect of diazepam is relatively weak, its half-life is relatively long, and the addiction is relatively large, mainly used for anxiolysis; escolam oral absorption is fast, more suitable for patients with difficulty falling asleep; alprazolam anxiolysis is the best, especially suitable for people with short sleep maintenance time (early awakening); and clonazepam has a strong sedative effect, especially for refractory insomnia.
Second, non-benzodiazepine sleeping pills: representative drugs: zolpidem, zalepron, zopiclone and dexzopiclone.
This is an advantage of the low risk of drug dependence caused by these drugs compared with thermoplasts and generally less likely to cause daytime drowsiness. However, this type of drug has almost no anxiolytic effect, the effect on anxiety insomnia is not as good as that of tranquilizers, in addition, its half-life is short, the maintenance sleep time is also short, mainly used for sleep disorders, occasional insomnia, for short sleep maintenance time (early awakening) is not effective.
3. Antidepressants: representative drugs: doxepine, fluvoxazamine, mirtazapine and trazodone.
Doxepine: the sedative effect is to use its antihistamine properties, the recommendation of foreign guidelines is based on the clinical study of the dose of 3mg and 6mg, while in China's doxepine only 25mg dosage specifications, therefore, often need to break open to take. It is characterized by the inability to produce withdrawal symptoms and is well tolerated clinically.
Fluvoxamine: both antidepressant effect and good sedative effect, the effect is relatively mild, for anxiety and depression insomnia is a better choice.
Small doses of mirtazapine and trazodone have a weaker antidepressant effect, but a stronger sedative effect, and can be used to treat insomnia and insomnia rebound after hypnotic drug discontinuation.
4. Melatonin and melatonin receptor agonists: representative drugs, melatonin, agomelatine, lemmelton.
Melatonin is not effective for refractory insomnia, however, melatonin may be effective in patients with reduced melatonin secretion, especially for jet lag symptoms and delayed sleep syndrome. It should be noted that melatonin on the market has common preparations and sustained-release preparations, ordinary preparations are more suitable for people with difficulty falling asleep, and sustained-release preparations are more suitable for people with short sleep maintenance time (early awakening).
Agomelatine is a melatonin receptor agonist and also a 5-HT receptor antagonist, therefore, has a dual sedative and antidepressant effect, capable of improving depressive disorder-related insomnia.
V. Other Drugs:
Orexin receptor antagonists: such as Suvolesin, which works by inhibiting the regulator of sleep arousal - orexin, therefore, Suvolesin is mostly used for mid-course awakenings, morning awakenings, deep sleep disorders.
Antiepileptic drugs: such as gabapentin, are mainly used for sleep disturbances associated with alcohol use disorder (AUD).
Antihistamines: representative drugs: diphenhydramine, chlorpheniramine. Guidelines do not recommend antihistamines for the treatment of insomnia, although such drugs have a sedative effect.
Antipsychotics; representative drugs: olanzapine, quetiapine. Among them, olanzapine exerts a sedative effect through antagonistic histamine receptors and can be used to treat paradoxical insomnia, but it is advisable to use it in short-term small doses and should not be taken for a long time.
Valerian extract: although it can increase slow-wave sleep, it can cause liver poisoning and is not recommended for the treatment of insomnia.
6. Proprietary Chinese medicine: representative medicine: cinnabar Anshen pill, Tianwang tonic pill, Baile Sleep capsule.
The disease of insomnia is in the heart, and it is also related to the liver and gallbladder, spleen and stomach, and kidneys. Insomnia is mostly caused by overwork, injury to the heart and spleen, yin and yang disorders, heart and kidney incompatibility or restlessness, or yin deficiency and fire, or lack of heart and gallbladder. The use of proprietary Chinese medicines must be dialectically treated, and there are three types of common tranquilizers, namely tonic tranquilizers, heavy town tranquilizers, and soothing tranquilizers.
1. Nourishing tranquilizers: such as Tianwang Heart Pills, Baizi Heart Pills, Heart Tonic Pills, Jujube Tranquilizer Granules, etc. It has the ability to nourish the heart and liver and calm the mind, and is suitable for the heart, liver, yin and blood deficiency, and the certificate of delirium loss.
Among them, jujube kernel tranquilizer granules are composed of sour jujube kernels, schisandra seeds, and salvia. Sour jujube kernel nourishes the heart and liver, calms the heart and calms the spirit, for the king's medicine; Schizandra is beneficial to the qi, tonifies the kidney and calms the heart, for the subject medicine; danshen nourishes the blood and activates the blood, removes the annoyance and calms the spirit, is an adjuvant, and the three medicines together make up the work of nourishing the blood and calming the god.
2, heavy town tranquilizer: such as magnetic Zhu pill, cinnabar anshen pill, etc. It has the power of heavy town tranquility, suitable for hyperactivity of the heart and yang, fiery disturbing heart evidence, heavy town tranquilizer class is mostly composed of golden stone drugs, should not be taken for a long time, so as not to hinder the spleen and stomach transport, affect the digestive function.
Among them, cinnabar anshen pills are composed of cinnabar, huanglian, ground yellow, angelica and licorice. Cinnabar purifies the heart and calms the spirit, as the main medicine; the heart fire has more than enough, with yellow diarrhea, camp yin has more, angelica, ground yellow supplement, as an adjunct; licorice slow and medium, for the medicine. It is used for upset in the chest, palpitations, insomnia and dreams.
3. Depression tranquilizer: such as sleep capsules, Baile sleep capsules, liver relief capsules, etc. It is suitable for liver qi depression, disturbance and mental illness.
Among them, Shu Sleep Capsule is composed of chai hu, sour jujube kernel, acacia flower, white peony, cicada metamorphosis, zombie silkworm and rush. Chai Hu thin liver depression as a king medicine; sour jujube kernel, acacia flower tranquility of the heart as a subject medicine; white peony nourishes the feminine liver, cicadas degenerate cool liver breath wind, zombie silkworm breath wind to stop spasm phlegm, rush grass to clear the heart and remove troubles, a total of adjuvant. The combination of various medicines, the joint performance of liver relief, calming the heart and calming the spirit.
In short, patients with long-term insomnia should be under the guidance of a specialist for standardized treatment, do not use drugs or increase the amount without authorization; long-term medication is easy to lead to dependence, and should gradually reduce drug dependence and discontinue drug through psychological and behavioral treatment; do not advocate continuous drug treatment, advocate intermittent treatment or on-demand treatment (except for antidepressants); long-term users should avoid abrupt termination of drug treatment to reduce drug rebound, and the method of reduction is to reduce the dose of the drug or change to intermittent treatment.