amakuru

Gusinzira ni indwara ikunze gusinzira, isobanurwa nk'indwara yo gusinzira ibaho amajoro atatu cyangwa arenga mu cyumweru, imara amezi arenga atatu, kandi ntabwo iterwa no kubura amahirwe yo gusinzira. Abagera kuri 10% bakuze bujuje ibisabwa kugirango badasinzira, naho abandi 15% kugeza 20% bavuga ko rimwe na rimwe ibimenyetso byo kudasinzira. Abarwayi badasinzira igihe kirekire bafite ibyago byinshi byo kwandura depression, hypertension, indwara ya Alzheimer, no gutakaza ubushobozi bwakazi.

Ibibazo by'amavuriro

Ibiranga kudasinzira ntabwo ari byiza gusinzira neza cyangwa igihe bimara, biherekejwe no gusinzira cyangwa gukomeza gusinzira, ndetse nububabare bukabije bwo mumutwe cyangwa kudakora kumanywa. Kudasinzira ni ikibazo cyo gusinzira kibaho amajoro atatu cyangwa arenga mu cyumweru, kimara amezi arenga atatu, kandi ntabwo giterwa n'amahirwe make yo gusinzira. Kudasinzira bikunze kubaho icyarimwe nizindi ndwara zumubiri (nkububabare), indwara zo mumutwe (nko kwiheba), nizindi ndwara zidasinzira (nka syndrome yamaguru ituje kandi apnea).

Kudasinzira ni indwara ikunze gusinzira mu baturage muri rusange, kandi ni kimwe mu bibazo bikunze kuvugwa iyo abarwayi bivuriza ku bigo nderabuzima, ariko akenshi ntibivurwe. Abagera kuri 10% bakuze bujuje ibisabwa kugirango badasinzira, naho abandi 15% kugeza kuri 20% byabantu bakuru bavuga ko rimwe na rimwe ibimenyetso byo kudasinzira. Kudasinzira bikunze kugaragara ku bagore no ku bantu bafite ibibazo byo mu mutwe cyangwa ku mubiri, kandi umubare wacyo uziyongera mu myaka yo hagati na nyuma yo hagati, ndetse no muri perimenopause na menopause. Turacyari tuzi bike kubijyanye na patologi na physiologique yuburyo bwo kudasinzira, ariko kuri ubu abantu bemeza ko gukabya imitekerereze ya psychologiya na physiologique aribyo byingenzi biranga.

Kudasinzira birashobora kuba ibintu cyangwa rimwe na rimwe, ariko abarwayi barenga 50% bafite ikibazo cyo kudasinzira bikabije. Kudasinzira kwambere mubisanzwe bituruka kubuzima bubi, ibibazo byubuzima, gahunda zakazi zidasanzwe, cyangwa gutembera mumwanya munini (itandukaniro ryigihe). Nubwo abantu benshi bazasubira mubitotsi bisanzwe nyuma yo kumenyera ibintu bitera, abakunze kudasinzira barashobora kugira ibitotsi bidakira. Ibintu bya psychologiya, imyitwarire, cyangwa umubiri akenshi biganisha kubibazo byo gusinzira igihe kirekire. Kudasinzira igihe kirekire biherekejwe no kwiyongera kwiheba rikomeye, hypertension, indwara ya Alzheimer, no gutakaza ubushobozi bwakazi.

Isuzuma no gusuzuma ibitotsi bishingiye ku iperereza rirambuye ku mateka y’ubuvuzi, ibimenyetso byerekana ibimenyetso, inzira y’uburwayi, indwara ziterwa n’ibindi bintu. Amasaha 24 yo gusinzira kubyuka imyitwarire irashobora kwerekana intego nyinshi zo kwitwara no kubungabunga ibidukikije. Raporo y’abarwayi yerekana ibikoresho byo gusuzuma hamwe n’ibitotsi birashobora gutanga amakuru yingirakamaro kumiterere nuburemere bwibimenyetso byo kudasinzira, gufasha mugukurikirana izindi ndwara zidasinzira, no gukurikirana iterambere ryubuvuzi

Ingamba n'ibimenyetso

Uburyo bugezweho bwo kuvura kudasinzira harimo imiti yandikiwe na imiti irenga imiti, imiti yo mu mutwe n’imyitwarire (izwi kandi nka cognitive-imyitwarire ivura [CBT-I] yo kudasinzira), hamwe n’ubuvuzi bundi bushya. Inzira isanzwe yo kuvura abarwayi ni ukubanza gukoresha imiti irenga imiti hanyuma ugakoresha imiti yandikiwe nyuma yo gushaka ubuvuzi. Abarwayi bake bahabwa imiti ya CBT-I, igice bitewe no kubura abavuzi batojwe neza.

CBTI-I
CBT-I ikubiyemo urukurikirane rw'ingamba zigamije guhindura imyitwarire n'imyitwarire ya psychologiya itera kudasinzira, nko guhangayika cyane n'imyizerere mibi yerekeye gusinzira. Ibyingenzi bikubiye muri CBT-I bikubiyemo ingamba zo guteganya imyitwarire no gusinzira (kubuza ibitotsi no kugenzura ibitera imbaraga), uburyo bwo kuruhuka, imitekerereze ya psychologiya na cognitive intervention (cyangwa byombi) bigamije guhindura imyizerere mibi no guhangayikishwa cyane no kudasinzira, ndetse no kwigisha isuku yo gusinzira. Ubundi buryo bwo kwivanga mubitekerezo nko Kwemera no Kwiyemeza Ubuvuzi hamwe no Gutekereza gushingiye ku buvuzi nabwo bwakoreshejwe mu kuvura ibitotsi, ariko hari amakuru make ashyigikira imikorere yabyo, kandi bigomba gukomezwa igihe kirekire kugirango bigirire akamaro. CBT-I nubuvuzi bwanditse bwibanda ku gusinzira kandi bushingiye kubibazo. Ubusanzwe iyobowe numuvuzi wubuzima bwo mumutwe (nka psychologue) kugirango bagire inama 4-8. Hariho uburyo butandukanye bwo gushyira mubikorwa CBT-I, harimo ifishi ngufi hamwe nitsinda ryitsinda, hitabiriwe nabandi bashinzwe ubuzima (nkabaforomo bakora imyitozo), ndetse no gukoresha telemedisine cyangwa urubuga rwa sisitemu.

Kugeza ubu, CBT-I irasabwa nkumurongo wambere wubuvuzi mumabwiriza yubuvuzi nimiryango myinshi yabigize umwuga. Igeragezwa rya Clinical na meta-isesengura ryerekanye ko CBT-I ishobora kuzamura cyane ibyavuye mu barwayi. Muri meta-isesengura ryibi bigeragezo, CBT-I nasanze itezimbere ubukana bwibimenyetso byo kudasinzira, igihe cyo gutangira ibitotsi, nigihe cyo gukangura ibitotsi. Iterambere ryibimenyetso byo kumanywa (nkumunaniro numutima) hamwe nubuzima bwiza ni bito, kuberako biterwa no gukoresha ingamba rusange zidakozwe muburyo budasinzira. Muri rusange, abarwayi bagera kuri 60% kugeza kuri 70% bafite ibisubizo by’amavuriro, aho igabanuka ry’amanota 7 mu rutonde rw’indwara ya Insomnia Severity Index (ISI), kuva ku manota 0 kugeza kuri 28, hamwe n’amanota menshi yerekana kudasinzira cyane. Nyuma yibyumweru 6-8 byo kuvurwa, abagera kuri 50% byabarwayi badasinzira bafite ikibazo cyo gukira (ISI amanota yose, <8), naho 40% -45% byabarwayi bagera kubakira amezi 12.

Mu myaka icumi ishize, CBT-I ya digitale (eCBT-I) yarushijeho gukundwa kandi amaherezo irashobora kugabanya itandukaniro rinini hagati ya CBT-I isaba kandi igerwaho. ECBT-I igira ingaruka nziza mubisubizo byinshi byo gusinzira, harimo ubukana bwo kudasinzira, gusinzira neza, gusinzira neza, gukanguka nyuma yo gusinzira, igihe cyo gusinzira, igihe cyose cyo gusinzira, n'umubare w'ibyuka bya nijoro. Izi ngaruka zisa nizigaragara mubigeragezo imbonankubone CBT-I kandi bikomeza ibyumweru 4-48 nyuma yo kubikurikirana.

Kuvura ingaruka mbi nko kwiheba nububabare budashira birashobora kugabanya ibimenyetso byo kudasinzira, ariko muri rusange ntibishobora gukemura byimazeyo ibibazo byo kudasinzira. Ibinyuranye nibyo, kuvura ibitotsi birashobora kunoza ibitotsi byabarwayi bafite ingaruka mbi, ariko ingaruka ziterwa nazo ubwazo ntabwo zihamye. Kurugero, kuvura kudasinzira birashobora kugabanya ibimenyetso byo kwiheba, kugabanya umuvuduko wubwiyongere nigipimo cyo kwiheba, ariko ntigire ingaruka nke kububabare budakira.

Uburyo bwo kuvura butandukanye burashobora gufasha gukemura ikibazo cyumutungo udahagije ukenewe mubuvuzi gakondo bwimitekerereze nimyitwarire. Uburyo bumwe butanga igitekerezo cyo gukoresha uburezi, kugenzura, nuburyo bwo kwifasha kurwego rwa mbere, ubuvuzi bwa digitale cyangwa mumatsinda yo mumitekerereze ya psychologiya hamwe nimyitwarire kurwego rwa kabiri, ubuvuzi bwa psychologique nimyitwarire kumuntu kurwego rwa gatatu, hamwe nubuvuzi bwimiti nkumugereka wigihe gito kuri buri rwego.

Kuvura imiti
Mu myaka 20 ishize, uburyo bwo kwandikisha imiti ya hypnotic muri Amerika bwagize impinduka zikomeye. Umubare wandikirwa na benzodiazepine reseptor agonist ukomeje kugabanuka, mugihe umubare wa trazodone wandikirwa ukomeje kwiyongera, nubwo ikigo cy’ibiribwa n’ibiyobyabwenge muri Amerika (FDA) kitigeze kivuga ko kudasinzira nk'ikimenyetso cya trazodone. Byongeye kandi, antagonist anti-appetit suppressant reseptor antagonist yatangijwe mumwaka wa 2014 kandi yarakoreshejwe cyane.

Ingano yingaruka yimiti mishya (igihe cyo gufata imiti,

Ibipimo bya Byeri (urutonde rw'ibiyobyabwenge bifatwa nkaho bidakwiriye ku barwayi bafite imyaka 65 cyangwa irenga) birasaba kwirinda gukoresha iyi miti.

Uyu muti ntabwo wemejwe na FDA yo kuvura ibitotsi. Ibiyobyabwenge byose byashyizwe kumeza byashyizwe mubikorwa byo gutwita C na Amerika yo muri Amerika, usibye ibiyobyabwenge bikurikira: Triazolam na Temazepam (Icyiciro X); Clonazepam (Urwego D); Diphenhydramine na docetamine (icyiciro B).
1. Benzodiazepine reseptor agonist ibiyobyabwenge hypnotic
Benzodiazepine reseptor agonist irimo imiti ya benzodiazepine nibiyobyabwenge bitari benzodiazepine (bizwi kandi nk'ibiyobyabwenge byo mu rwego rwa Z). Igeragezwa rya Clinical hamwe na meta-isesengura ryerekanye ko benzodiazepine reseptor agonist ishobora kugabanya igihe cyo gusinzira, kugabanya kubyuka nyuma yo gusinzira, no kongera gato igihe cyose cyo gusinzira (Imbonerahamwe 4). Nk’uko raporo z’abarwayi zibitangaza, ingaruka ziterwa na benzodiazepine reseptor agonist zirimo anterograde amnesia (<5%), kwikinisha bukeye (5% ~ 10%), hamwe n imyitwarire igoye mugihe cyo gusinzira nko kurota ku manywa, kurya, cyangwa gutwara (3% ~ 5%). Ingaruka zanyuma zatewe nisanduku yumukara iburira zolpidem, zaleplon, na escitalopram. 20% kugeza kuri 50% by'abarwayi bafite kwihanganira ibiyobyabwenge ndetse no guterwa na physiologique nyuma yo gufata imiti buri joro, bikagaragaza nko kudasinzira cyane hamwe na syndrome de syndrome.

2. Imiti igabanya ubukana bwa heterocyclic
Imiti igabanya ubukana, harimo imiti ya tricyclike nka amitriptyline, demethylamine, na doxepin, hamwe n’ibiyobyabwenge bya heterocyclic nka olanzapine na trazodone, bikunze kwandikirwa imiti yo kuvura ibitotsi. Gusa doxepin (3-6 mg buri munsi, ifatwa nijoro) yemejwe na FDA yo muri Amerika kuvura indwara yo kudasinzira. Ibimenyetso biriho byerekana ko imiti igabanya ubukana ishobora kunoza ibitotsi, gusinzira neza, no kongera igihe cyo gusinzira, ariko ntigire ingaruka nke kumara igihe cyo gusinzira. Nubwo FDA yo muri Amerika idashyira urutonde rwo kudasinzira nkikimenyetso cyerekana iyi miti, abaganga n’abarwayi bakunze guhitamo iyi miti kuko igira ingaruka zoroheje ku kigero gito kandi uburambe bw’amavuriro bwerekanye akamaro kabo. Ingaruka zinyuranye zirimo kwikinisha, umunwa wumye, gutinda k'umutima, hypotension, na hypertension.

3. Kurwanya ibyifuzo byo kurya
Neuron irimo orexine muri hypothalamus ikurikira itera nuclei mu bwonko na hypothalamus itera gukanguka, kandi ikabuza nuclei mu gice cya ventrale na medial preoptic itera gusinzira. Ibinyuranye nibyo, guhagarika ubushake bwo kurya birashobora kubuza gutwara imitsi, guhagarika gukanguka, no guteza ibitotsi. Ibintu bitatu bibiri bya orexin reseptor antagonistes (sucorexant, lemborxant, na daridorexint) byemejwe na FDA yo muri Amerika kuvura indwara yo kudasinzira. Igeragezwa rya Clinical rishyigikira imikorere yabo mugitangira no gusinzira. Ingaruka kuruhande zirimo kwikinisha, umunaniro, no kurota bidasanzwe. Bitewe no kubura imisemburo ya endogenous appetit, ishobora gutera narcolepsy hamwe na cataplexy, antagonist hormone ya apetite iranduzwa mubarwayi nkabo.

4. Melatonin na melatonin reseptor agonist
Melatonin ni imisemburo isohorwa na gine ya pine mu bihe byijimye nijoro. Exogenous melatonin irashobora kugera kumaraso arenze urugero rwa physiologique, hamwe nibihe bitandukanye bitewe na dosiye yihariye. Igipimo gikwiye cya melatonine yo kuvura ibitotsi ntikiramenyekana. Ibigeragezo bigenzurwa birimo abantu bakuru byerekanye ko melatonine igira ingaruka nke mugutangira gusinzira, nta nkurikizi zigira kubyuka mugihe cyo gusinzira no kumara ibitotsi. Imiti ihuza reseptor ya melatonin MT1 na MT2 yemejwe kuvura indwara yo kudasinzira neza (ramelteon) hamwe no gusinzira ibitotsi (tasimelteon). Kimwe na melatonine, iyi miti nta ngaruka igira ku gukanguka cyangwa igihe cyose cyo gusinzira nyuma yo gusinzira. Gusinzira n'umunaniro ni ingaruka zikunze kugaragara.

5. Ibindi biyobyabwenge
Antihistamine mu miti irenga imiti (diphenhydramine na docetamine) hamwe n’imiti yandikiwe (hydroxyzine) niwo muti ukoreshwa cyane mu kudasinzira. Amakuru ashyigikira imikorere yayo ni ntege nke, ariko kubageraho no kubona umutekano kubarwayi bishobora kuba impamvu yo gukundwa kwabo ugereranije na benzodiazepine reseptor agonist. Antihistamine yangiza irashobora gutera kwikinisha cyane, ingaruka za anticholinergique, kandi bikongera ibyago byo guta umutwe. Gabapentin na pregabalin bakunze gukoreshwa mu kuvura ububabare budashira kandi ni n'imiti yo kuvura umurongo wa mbere kuri syndrome yamaguru ituje. Iyi miti igira ingaruka zo gukurura, kongera ibitotsi bitinda, kandi ikoreshwa mukuvura ibitotsi (birenze ibimenyetso), cyane cyane iyo biherekejwe nububabare. Umunaniro, gusinzira, kuzunguruka, na ataxia ni ingaruka zikunze kugaragara.

Guhitamo imiti ya hypnotic
Niba imiti yatoranijwe kugirango ivurwe, benzodiazepine yakira reseptor agonist, antagonist orexin, cyangwa imiti ikabije ya heterocyclicike niyo ihitamo ryambere mubihe byinshi byubuvuzi. Benzodiazepine reseptor agonist irashobora kuba uburyo bwiza bwo kuvura abarwayi badasinzira bafite ibimenyetso byo gusinzira, abarwayi bakuze bato, nabarwayi bashobora gusaba imiti yigihe gito (nko kudasinzira kubera guhangayika bikabije cyangwa burigihe). Iyo uvura abarwayi bafite ibimenyetso bifitanye isano no gukomeza gusinzira cyangwa kubyuka kare, abantu bageze mu za bukuru, hamwe n’abafite imiti ikoreshwa nabi cyangwa gusinzira, imiti ikabije ya heterocyclic cyangwa imiti igabanya ubukana irashobora guhitamo bwa mbere.

Ukurikije ibipimo bya Beers, urutonde rwibiyobyabwenge bidakwiriye kubarwayi bafite imyaka 65 cyangwa irenga birimo benzodiazepine reseptor agonist hamwe nibiyobyabwenge bya heterocyclic, ariko ntabwo birimo doxepin, trazodone, cyangwa orexin antagonist. Imiti yambere isanzwe ikubiyemo gufata imiti buri joro ibyumweru 2-4, hanyuma ukongera gusuzuma ingaruka n'ingaruka. Niba hakenewe imiti yigihe kirekire, shishikariza imiti rimwe na rimwe (inshuro 2-4 mu cyumweru). Abarwayi bagomba kuyoborwa gufata imiti iminota 15-30 mbere yo kuryama. Nyuma yimiti yamara igihe kirekire, abarwayi bamwe bashobora kwandura ibiyobyabwenge, cyane cyane iyo bakoresheje benzodiazepine reseptor agonist. Nyuma yo gukoresha igihe kirekire, kugabanuka guteganijwe (nko kugabanukaho 25% buri cyumweru) birashobora gufasha kugabanya cyangwa guhagarika imiti ya hypnotic.

Guhitamo hagati yubuvuzi hamwe na monotherapy
Ubushakashatsi buke buriho kumutwe ugereranya bwerekanye ko mugihe gito (ibyumweru 4-8), imiti ya CBT-I hamwe na hypnotic (cyane cyane imiti yo mu rwego rwa Z) igira ingaruka zisa mukuzamura ibitotsi, ariko kuvura ibiyobyabwenge bishobora kongera igihe cyose cyo gusinzira ugereranije na CBT-I. Ugereranije no gukoresha CBT-I yonyine, kuvura bivanze birashobora gutuma ibitotsi byihuta, ariko iyi nyungu igabanuka buhoro buhoro mucyumweru cya kane cyangwa icya gatanu cyo kuvura. Byongeye kandi, ugereranije nubuvuzi cyangwa kuvura hamwe, ukoresheje CBT-I wenyine birashobora kunoza ibitotsi ubudacogora. Niba hari ubundi buryo bworoshye bwo gufata ibinini byo kuryama, abarwayi bamwe bubahiriza inama zimyitwarire birashobora kugabanuka.