・ Today, it is reported that about 1 in 5 people in Japan have sleep problems. Insomnia is the center of sleep disorders. According to a sleep survey conducted by the Ministry of Health, Labor and Welfare on about 6,500 people aged 3 to 99 years old, about 40% of women and 30% of men have trouble with sleep problems, about 36 in total. %, It is reported that about 20% of women and 19% of men are currently having trouble with sleep problems, and 19.6% of the total. In addition, it is reported that about 12% of the people have been suffering from long-term insomnia for more than 1 month, and 1 in 10 people are suffering from long-term insomnia.
・ Reflecting the 24-hour lifestyle and the busy and stressful modern society, the number of people who complain of insomnia is on the rise, and in addition, the number of elderly people who are prone to insomnia is increasing. Then, insomnia symptoms are expected to become more common than lifestyle-related diseases in the future. Therefore, it seems inevitable that the importance of dealing with and treating insomnia will increase, but on this page, we will explain the symptoms, causes, and drug therapy of insomnia.
【What is insomnia?】
Regardless of the actual length of sleep, it is a state of complaining of lack of sleep, causing physical, mental and social problems.
According to the International Classification of Sleep Disorders ICSD2 (below), “repeated disorders in the onset, duration and quality of sleep are observed, and despite appropriate opportunities to sleep, physical, mental and social disorders to sleep occur. As a result, it is defined as a condition that causes disability in daily life.
ICSD2Diagnostic criteria for general insomnia in the International Classification of Sleep Disorders
A. There are complaints about sleep quality and maintenance
B. Occurring under proper sleep hygiene
C. At least one of the following daytime dysfunctions is observed
・ Fatigue or indefinite complaints
・ Impaired concentration, attention, and memory
・ Decline in social function
・ Mood disorder or frustration
・ Daytime sleepiness
・ Palpitations, impaired motivation
・ Danger of mistakes and accidents during work and driving
・ Tension, headache, digestive symptoms associated with lack of sleep
・ Sleep anxiety
【Causes of insomnia】
The causes of insomnia include primary, physical illness, psychiatric illness, and those associated with drugs, and are briefly divided into five in clinical situations.
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2.physiological reasonsJet lag, shift work (difference between biological clocks or between biological clocks and social external environment (time)), aging
3.mental illnessAssociated with emotional disorders, schizophrenia, anxiety disorders, etc.
4.psychological reasons; Caused by psychological conflict such as anxiety
5.Pharmacological cause; Antihypertensive drug, steroid drug, thyroid drug, asthma drug, alcohol, caffeine, etc.
We will treat insomnia while considering these causes.
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In addition to the above, these days, work and life stress, inappropriate sleep habits (looking at the screen of a computer or TV until just before going to bed, being exposed to bright light at a convenience store, etc., late hours Increasingly, insomnia is caused by overtime work or work until just before going to bed.
【Classification by symptoms of insomnia】
Insomnia can be broadly divided into four types according to the symptoms.
・Sleep disorder: I can’t fall asleep at night, and it takes more than 2 hours to fall asleep.
Since sleep onset disorders are often associated with psychiatric disorders such as schizophrenia, mania, and anxiety disorders (in addition to insomnia), it is necessary to confirm the presence or absence of psychiatric symptoms.
・Awakening halfway: Symptoms such as waking up more than once in the middle of the night after falling asleep, and not being able to fall asleep after waking up halfway.
Especially in middle-aged and older men, awakening is the main symptom of sleep apnea, and other than apnea, snoring, fatigue when waking up, and daytime sleepiness are often complained. (For details, see the outdoor shirt The North Face 22 Spring / Summer Rear View Full Zip Hoodie Men’s S Black (K), orSuimin.comFree shipping Frozen costco Costco Nichirei Scented Grie hamburger 120g x 10 pieces 1200g)
If you do not notice sleep apnea and take intermediate / long-acting hypnotics, these drugs promote respiratory depression and worsen apnea (low) breathing, so be careful. Is required.
(At our hospital, we can perform a simple test to screen for sleep apnea. We will take the measuring instrument home for testing.)
・Early morning awakening: It is a symptom that I wake up more than 2 hours earlier than usual in the morning and cannot fall asleep again after waking up. It is often associated with depression.
Therefore, if early-morning awakening is observed, check for depression when waking up (depressive mood), decreased motivation during the day, and restraint symptoms (slow head rotation, inability to concentrate). need to do it.
・Deep sleep disorderIt is a symptom that you cannot sleep soundly or you cannot get a feeling of sleep because you sleep lightly. It can be seen with aging, stress, sleep apnea, and mental illness.
【Insomnia classification】
ICSD2 (International Classification of Sleep Disorders) classifies insomnia as follows.
・Psychotic rational insomniaIt is the most common insomnia. It accounts for 15% of insomnia in Japan. Psychological and chronic insomnia with no psychological symptoms. (For details, see another page on this site, orSuimin.comPlease refer to Pants FORK & SPOON Color Pants)
・ Paradoxical insomnia; Although there are no definite factors that cause insomnia, serious complaints of insomnia continue. The problem is that the self-assessment of sleep is lower than the objective indicators of sleep (for example, data measured by sleep EEG). (Example: You are objectively sleeping well, but you think you are not sleeping, etc.)
Idiopathic insomnia; insomnia that persists for a long period of time (until now) from childhood, with no apparent cause. At present, the cause of this disease is unclear.
Adjustment disorder insomnia; Short-term insomnia caused by a definite stress factor and disappearing when the factor disappears.
・ When sleep hygiene (lifestyle for sleep) is inappropriate
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・ Others: Insomnia caused by drugs, insomnia caused by physical illness
【Effects of insomnia】
We have listed some of the most well-known effects of insomnia and sleep deprivation.
high blood sugarContinued sleep deprivation can lead to overeating, hyperglycemia, and impaired glucose tolerance. It has been reported that the risk of developing diabetes is 1.5 times higher than those with insomnia.
High blood pressureIt has been reported that the risk of developing hypertension is 1.8 times higher than those with insomnia.In insomniaNoradrenaline is highIs reported to be.
depressionIt has been reported that if insomnia does not improve for a year, the risk of developing depression is 40 times higher. It has been pointed out that insomnia is the cause of depression, that insomnia may be a precursor to depression, and that there may be factors common to insomnia and the onset of depression.
【Use of sleeping pills according to insomnia】
Explains how to use sleeping pills for general insomnia (those that do not have psychological symptoms, substance or physical causes other than insomnia symptoms).
Hypnotics generally depend on the duration of action.Ultra short time type ２．Short time type ３．Intermediate ４．Long-time typeIt is classified into four categories. The duration of action is basically defined by the half-life of blood concentration, but the kinetics of metabolite activity is also taken into consideration. The characteristics of sleeping pills are summarized (Table 1).
Ultra-short-acting type is a sleep-inducing agentIt is also calledIt is a drug that has an early onset of effect, but it is not a weak drug. Similarly, long-acting sleeping pills are not strong drugs.
The ultra-short-time type and short-time action type are suitable for introducing sleep, and are characterized by the fact that the effect of lasting the next day is often difficult to appear. On the other hand, long-acting sleeping pills often have carry-over effects such as difficulty in getting up and daytime sleepiness, and are not suitable for cases where only poor sleep is a problem.
It is desirable to administer sleeping pills by comparing the duration of action of the sleeping pills with the symptoms of insomnia and the quality of sleep. In addition, since the effects of sleeping pills vary greatly from person to person, it is necessary to adjust the type and dose of the drug while carefully observing the effects after administration.
【Choosing sleeping pills for the elderly]When using sleeping pills for the elderly, 1. Avoid long-acting sleeping pills; likely to reduce daytime alertness levels, high risk of falls 2. It is important to note that you should avoid sleeping pills that have a strong muscle relaxant effect.
Therefore, the options are 1. 2. Select an ultra-short-acting / short-acting sleeping pill and keep it in a small amount. Drugs with weak muscle relaxant action (ω1 selective hypnotics) such as zopiclone (Amoban) and zolpidem (Mysley) are listed as the top choices.If you are at high risk of using sleeping pillsRamelteonConsider administration of (Rozelem).In the elderlyMelatoninIt has been pointed out that melatonin may be effective in terms of cognitive function as well as decreased secretion. Considering safety and benefits, melatonin receptor agonists may be the first choice for insomnia in the elderly.
【Drug-free method】
There are sleep hygiene, stimulus adjustment methods, and stimulus adjustment methods to deal with insomnia without using drugs. (Details are on another page of this sitepsychophysiological insomnia,or,Suimin.comKUSAKURA JZ Tobori special double woven judo trousers only 5Y size (slim size) JZP5Y Martial arts wear 15SS)
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Discontinuation of sleeping pillsHas improved insomnia1 month or moreYou need to make sure that you’re on track and that you’re not worried about stopping the drug, which is based on getting the right sleep habits.On the contrary, it is dangerous to discontinue the drug easily without improving sleep hygiene and lifestyle. Ideally, the drug should be gradually reduced over the course of several weeks, paying attention to the relapse of insomnia fear.
When discontinuing ultra-short-acting / short-acting sleeping pillsGradual reduction methodIs used (Fig. 1). It is a method to reduce sleeping pills by 1/4 over 2-4 weeks and stop over 4-8 weeks. If insomnia relapses or worsens due to weight loss, return to the dose before weight loss, observe the course for at least 1 month, and try re-administration.
If the tapering method does not work, replace it with a sleeping pill with a long half-life (Note DBA-NE12 engine 10102-3VA1G-Fig. 1) There is also a method to consider gradual decrease.
In the intermediate type and long-acting type, after reducing the amount of sleeping pills by the tapering methodevery other dayMay also be used. (Fig. 1) With a drug with a long half-life, the blood concentration gradually decreases, so rebound insomnia and withdrawal symptoms are less likely to occur, and it becomes easier to use a method of setting a day when no sleeping pill is taken and extending the interval. increase.
