6. ์ฐ์ธ์ฆ
๏จ Lifetime prevalence: 9% ~26%
๏จ Risk is greatest during the childbearing
years
๏จ Pregnancy does not protect women from
depression
๏จ Untreated depression/anxiety can have
negative fetal/obstetrical and neonatal
outcomes
๏จ Risk factors
๏ค ์ฌ์ฑํธ๋ฅด๋ชฌ์ ๊ธ๋ณ , ์๋ฉด๋ฐํ
๏ค ์๋ก์ด ํ์ต์๊ตฌ๋ ์ฆ๊ฐ (=high burden)
๏ค ์ฌํ์ํ์ ์ ํ
9. ๋ถ๋ฉด์ฆ
๏จ Conditioned insomnia
๏ค ์ ์ ์๋ ค๋ โ์๋โ์ ์ฐ๊ด๋์ด conditioned arousal ์ด ์๊ธด ๊ฒฝ์ฐ
๏ค ์ ๊ณผ ๊ด๋ จ๋ ๊ฒ ( ์นจ๋ , ์นจ์ค ) ๋ฑ์ ๋ถ๋ฉด์ ์ ๋ฐํ๋ ์กฐ๊ฑดํ๋ ์๊ทน์ด ์๋ค
๏จ ํน์ง
๏ค Daytime adaptation is generally good
๏ค Work and relationship are satisfying (extreme tiredness can exist)
๏ค Excessive worry about not being able to sleep
๏ค Trying too hard to sleep
๏ค Rumination, inability to clear oneโs mind while trying to sleep
๏ค Increased muscle tension when attempting to sleep
๏ค Other somatic manifestations of anxiety
๏ค Being able to sleep better away from oneโs own bed-room
๏ค Being able to fall asleep when not trying (e.g. watching TV)
๏จ ์น๋ฃ
๏ค ์๋ฉด์ ๋ ์๊ปด์ ์ฌ์ฉ : ์ต์ํ์ ํจ๊ณผ์ ์ธ ์ฉ๋
๏ค Stimulus control therapy, sleep hygiene ๊ฐ์ , relaxation therapy
11. ์๋ฉด ์์ : Sleep hygiene method
๏จ 1. Arise at the same time daily
๏จ 2. Limit daily in-bed time to the usual amount present before the sleep
disturbance
๏จ 3. Discontinue CNS-acting drugs (caffeine, nicotine, alcohol, stimulant)
๏จ 4. Avoid daytime naps
(except when sleep chart show they induce better night sleep)
๏จ 5. Establish physical fitness by means of a graded program of vigorous
exercise early in the day
๏จ 6. Avoid evening stimulation
(substitute radio or relaxed reading for television)
๏จ 7. Try very hot, 20min, body-temp-raising bath soak near bedtime
๏จ 8. Eat at regular times daily : avoid large meals near bedtime
๏จ 9. Practice evening relaxation routines, such as progressive muscle
relaxation or meditation
๏จ 10. Maintain comfort sleeping condition
12. ๋ถ๋ฉด์ฆ์ ์ฝ๋ฌผ ์น๋ฃ
โข Zolpidem (FDA class C)
โข Non-benzodiazepine hypnotics
โข Stilnox IR 10mg, Stilnox CR 6.25mg, 12.25mg
โข Benzodiazapines (FDA class D)
โข Triazolam(halcion)
โข Alprazolam(xanax), Lorazapam(ativan),
Clonazepam(rivotril), Diazepam(valium)
โข Melatonin (FDA class C): 7 ์ launching ์์
โข Sedating antidepressant: mirtazapine
โข ์๋์ sedating antipsychotics: quetiapine
12.5~25mg
โข Doxylamine (FDA class A)