วันอังคารที่ 13 กรกฎาคม พ.ศ. 2553

650. Insomnia

ในการตรวจที่ OPD จะพบภาวะนอนไม่หลับเป็นประจำ จะมีแนวทางการตรวจวินิจฉัยและรักษาอย่างไร?

Types and causes of insomnia
Selected causes of acute insomnia (< 30 days)*
Situational stress (e.g., occupational, interpersonal, financial, academic, medical)Environmental stressors (e.g., noise)
Death or illness of a loved one
Selected causes of chronic insomnia (≥ 30 days)
-Medical disorders
Arthropathies, cancer, chronic pain, congestive heart failure, COPD, end-stage renal disease, gastroesophageal reflux disease, HIV/AIDS, hyperthyroidism, nocturia caused by prostatic hypertrophy, stroke
-Medications
Anticholinergic agents; antidepressants (SSRIs, bupropion [Wellbutrin]), MAOIs; antiepileptics (lamotrigine [Lamictal], phenytoin [Dilantin]); antineoplastics; beta blockers; bronchodilators (beta agonists); CNS stimulants (methylphenidate [Ritalin], dextroamphetamine [Dextrostat], nicotine [Nicotrol]); interferon alfa; miscellaneous (diuretics, atorvastatin [Lipitor], levodopa, quinidine); steroids, oral contraceptives, progesterone, thyroid hormone
-Primary sleep disorder
Periodic limb movement disorder, restless legs syndrome, sleep apnea
-Psychiatric disorders
Anxiety disorders, bipolar disorder or schizophrenia, major depressive or dysthymic disorders, personality disorders, post-traumatic stress disorder
-Sleep–wake schedule disorder
Irregular sleep–wake cycle, jet lag, shift work
-Substance abuse
Alcohol, caffeine, drug withdrawal, stimulants (e.g., amphetamines, methamphetamines)

Evaluation and treatment of insomnia

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