作者/鈺璽診所院長黃鈞蔚醫師
門診中最常見的是失眠患者,很多人有睡不好的問題,分兩種極端情形,一種是用盡各種方法都無法入眠,逼不得已才前來門診,大部份對於「吃安眠藥」頗有成見,擔心吃多了會成癮、失智等等;另一類型則是只要睡不著就求助門診,不願真正面對心理問題、改善生活環境等,來門診的目的就是要拿藥。
到底安眠藥好不好、該不該吃?
在說明藥物治療之前,要先端正大家關於治療失眠的目標的錯誤觀念。根據國外文獻的定義,失眠的治療目標如下:
1.提升睡眠品質
2.改善失眠對白天所造成的影響
3.減少入睡時間和醒來次數
4.增加總睡眠時間
根據這些治療目標,要改善失眠的問題,一定要調整自己不良的生活習慣、增加運動的次數與強度、注意飲食及身心健康狀態,最後才是藉由藥物的協助。
然而,台灣人到底有多愛吃安眠藥呢?根據衛福部食藥署統計,2014年國人的安眠藥使用量已經高達三億三千九百多萬粒,創下史上新高紀錄,藥片串起來約等於一條中山高速公路加一條雪山隧道的長度,其中以能快速入睡的佐沛眠(Zolpidem)成分達一億三千七百多萬粒佔最多。
這些數據顯示一般民眾在改變自己的健康習慣前,就已經先習慣藉由安眠藥物來治療失眠的問題。再加上藥物的取得比起用心理治療處理失眠背後的主因來的更容易、廉價,也漸漸養成大家習慣性在就醫的時候就開口跟醫師要求開立安眠藥。
俗稱的鎮定劑,安眠藥等,目前市面上廣為使用的都是一種BZD類的藥物。翻譯作苯二氮類藥物,這類藥物會作用在人體中樞神經細胞上的GABA-A接受體上面,與α-1、α-2、α-3及其他次單元結合,透過打開氯離子通道使其進入細胞內,進而達到鎮靜、安眠、抗焦慮、抗痙攣或肌肉鬆弛的效果。
後來有科學家發明了Z-drug(Zolpidem, Zopiclone, Zaleplon, etc.)這些藥物藥效更快速,作用時間更短,比較不會有第二天昏沉的問題,雖然一開始號稱很安全,但隨著使用經驗增加,越來越多使用者出現夢遊的現象,而且,正因為他們藥效快速,所以成癮性比傳統的BZD類藥物更高,更難戒除。
近年來,有些朋友也嘗試過褪黑激素,目前全世界只有在美國或澳洲您可以在超市或是一般藥房就買到,不需經過醫師處方。不過由於褪黑激素台灣並未核准上市,所以不能拿來公然販售。而且,畢竟食品等級的褪黑激素在品管要求上與藥品的標準不同,所以常常會有吃了像沒吃的情況發生。
台灣目前唯一由衛福部核准的,是一種名為Ramelteon的藥物,姑且稱它是一種人工合成的褪黑激素,但其實它的強度是一般市售褪黑激素的3-6倍,也僅作用在M1, M2兩個特殊的接受體上,不僅跟傳統安眠藥物相比安全得多,必須經由醫師處方的Ramelteon,在品管上也絕對比食品等級的市售褪黑激素嚴格的多。
提醒大家,睡不著、失眠絕對不是自己在家裡喝喝酒助眠就好,也不是隨便找個醫生開安眠藥,昨天吃一顆,今天心情比較差就自己再加一顆;如果有失眠的問題,務必尋求專業、專科醫師的諮詢與協助。專業醫師能透過心理諮商找出問題所在,再輔以藥物治療,讓你一步一步遠離失眠。
文章來源:康健雜誌http://www.commonhealth.com.tw/blog/blogTopic.action?nid=2704
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真的很謝謝黃醫師!
家人交換吃藥也很可怕!
失眠絕對不是自己在家裡喝喝酒助眠就好! right!
洪凱駖藥師~ Solving a long-standing mystery about the desert’s rock art canvas Petroglyphs are carved in a material called rock varnish, the origins of which have been debated for years. Now, scientists argue it’s the result of bacteria and an adaptation that protects them from the desert sun’s harsh rays. By Nathan Collins 5923141600_1bc3f25867_k.jpg Rock art featuring human and animal forms and handprints Petroglyphs at Mesa Verde National Park, Colorado (Christine Fry & Peter Russo) Wander around a desert most anywhere in the world, and eventually you’ll notice dark-stained rocks, especially where the sun shines most brightly and water trickles down or dew gathers. In some spots, if you’re lucky, you might stumble upon ancient art – petroglyphs – carved into the stain. For years, however, researchers have understood more about the petroglyphs than the mysterious dark stain, called rock varnish, in which they were drawn. In particular, science has yet to come to a conclusion about where rock varnish, which is unusually rich in manganese, comes from. Now, scientists at the California Institute of Technology, the Department of Energy’s SLAC National Accelerator Laboratory and elsewhere think they have an answer. According to a recent paper in Proceedings of the National Academy of Sciences, rock varnish is left behind by microbial communities that use manganese to defend against the punishing desert sun. The mystery of rock varnish is old, said Usha Lingappa, a graduate student at Caltech and the study’s lead author. “Charles Darwin wrote about it, Alexander von Humboldt wrote about it,” she said, and there is a long-standing debate about whether it has a biological or inorganic origin. But, Lingappa said, she and her colleagues didn’t actually set out to understand where rock varnish comes from. Instead, they were interested in how microbial ecosystems in the desert interact with rock varnish. To do so, they deployed as many techniques as they could come up with: DNA sequencing, mineralogical analyses, electron microscopy, and – aided by Stanford Synchroton Radiation Lightsource (SSRL) scientist Samuel Webb – advanced X-ray spectroscopy methods that could map different kinds of manganese and other elements within samples of rock varnish. “By combining these different perspectives, maybe we could draw a picture of this ecosystem and understand it in new ways,” Lingappa said. “That’s where we started, and then we just stumbled into this hypothesis” for rock varnish formation. Among the team’s key observations was that, while manganese in desert dust is usually in particle form, it was deposited in more continuous layers in varnish, a fact revealed by X-ray spectroscopy methods at SSRL that can tell not only what chemical compounds make up a sample but also how they are distributed, on a microscopic scale, throughout the sample. That same analysis showed that the kinds of manganese compounds in varnish were the result of ongoing chemical cycles, rather than being left out in the sun for millennia. That information, combined with the prevalence of bacteria called Chroococcidiopsis that use manganese to combat the oxidative effects of the harsh desert sun, led Lingappa and her team to conclude that rock varnish was left behind by those bacteria. For his part, Webb said that he always enjoys a manganese project – “I’ve been a mangaphile for a while now” – and that this project arrived at the perfect time, given advances in X-ray spectroscopy at SSRL. Improvements in X-ray beam size allowed the researchers to get a finer-grained picture of rock varnish, he said, and other improvements ensured that they could get a good look at their samples without the risk of damaging them. “We’re always tinkering and fine-tuning things, and I think it was the right time for a project that maybe 5 or 10 years ago wouldn’t really have been feasible.” The research was supported by the National Science Foundation, the National Institutes of Health and the National Aeronautics and Space Administration. SSRL is a DOE Office of Science user facility. Citation: Usha F. Lingappa et al., Proceedings of the National Academy of Sciences, 22 June 2021 (10.1073/pnas.2025188118) For questions or comments, contact the SLAC Office of Communications at communications@slac.stanford.edu. SLAC is a vibrant multiprogram laboratory that explores how the universe works at the biggest, smallest and fastest scales and invents powerful tools used by scientists around the globe. With research spanning particle physics, astrophysics and cosmology, materials, chemistry, bio- and energy sciences and scientific computing, we help solve real-world problems and advance the interests of the nation. SLAC is operated by Stanford University for the U.S. Department of Energy’s Office of Science. The Office of Science is the single largest supporter of basic research in the physical sciences in the United States and is working to address some of the most pressing challenges of our time. X-ray Science X-ray Spectroscopy Stanford Synchrotron Radiation Lightsource (SSRL)