labarai

Rashin barci shi ne matsalar barci da aka fi sani, wanda aka bayyana shi a matsayin matsalar barci da ke faruwa dare uku ko fiye a kowane mako, yana ɗaukar fiye da watanni uku, kuma ba ya haifar da rashin damar barci. Kimanin kashi 10% na manya sun cika ka'idojin rashin bacci, kuma wani kashi 15% zuwa 20% na rahoton alamun rashin bacci lokaci-lokaci. Masu fama da rashin barci na dogon lokaci suna cikin haɗarin haɓaka babban baƙin ciki, hauhawar jini, cutar Alzheimer, da asarar ƙarfin aiki.

Matsalolin asibiti

Siffofin rashin bacci sune rashin gamsuwa da ingancin bacci ko tsawon lokaci, tare da wahalar bacci ko kula da barci, da kuma tsananin damuwa na tunani ko rashin aiki na rana. Rashin barci wata cuta ce da ke faruwa dare uku ko fiye a mako, yana ɗaukar fiye da watanni uku, kuma ba ya haifar da ƙarancin damar barci. Rashin barci sau da yawa yana faruwa a lokaci guda tare da wasu cututtuka na jiki (kamar ciwo), cututtuka na tunani (kamar damuwa), da sauran matsalolin barci (kamar ciwon ƙafa da rashin barci).

Rashin barci shi ne matsalar barci da aka fi sani a tsakanin jama’a, haka nan kuma yana daya daga cikin matsalolin da aka fi yawan ambatawa a lokacin da marasa lafiya ke neman magani a cibiyoyin kiwon lafiya na farko, amma sau da yawa ba a yi musu magani ba. Kimanin kashi 10 cikin 100 na manya sun cika ka'idojin rashin barci, kuma wani kashi 15 zuwa 20% na manya suna ba da rahoton alamun rashin bacci lokaci-lokaci. Rashin barci ya fi yawa a cikin mata da masu fama da tabin hankali ko na jiki, kuma adadin sa zai karu a tsakiyar shekaru da kuma bayan shekaru masu yawa, da kuma lokacin da ba a yi la'akari da su ba. Har yanzu mun san kadan game da hanyoyin cututtukan cututtuka da na ilimin halittar jiki na rashin barci, amma a halin yanzu an yi imani da cewa wuce gona da iri na tunani da physiological shine ainihin halayensa.

Rashin barci na iya zama na yanayi ko na lokaci-lokaci, amma sama da kashi 50% na marasa lafiya suna fama da rashin barci mai tsayi. Rashin bacci na farko yakan samo asali ne daga yanayin rayuwa mai cike da damuwa, al'amuran kiwon lafiya, jaddawalin aikin da ba na al'ada ba, ko tafiya cikin yankuna da yawa (bambancin lokaci). Ko da yake yawancin mutane za su koma barci na yau da kullum bayan sun dace da abubuwan da suka faru, wadanda ke da wuyar rashin barci na iya samun rashin barci na yau da kullum. Abubuwan da suka shafi tunanin mutum, halayya, ko na zahiri sukan haifar da matsalolin barci na dogon lokaci. Rashin barci na dogon lokaci yana tare da ƙara haɗarin babban baƙin ciki, hauhawar jini, cutar Alzheimer, da asarar ikon aiki.

Ƙididdiga da ganewar rashin barci sun dogara da cikakken bincike na tarihin likita, rikodin bayyanar cututtuka, yanayin rashin lafiya, cututtuka, da sauran abubuwan da ke haifar da su. Rikodin halayen bacci na awa 24 na iya gano ƙarin ɗabi'a da manufofin sa baki na muhalli. Kayan aikin tantance marasa lafiya da littattafan bacci na iya ba da bayanai masu mahimmanci game da yanayi da tsananin alamun rashin bacci, taimakawa allo don sauran cututtukan bacci, da lura da ci gaban jiyya.

Dabaru da Shaida

Hanyoyin da ake amfani da su a halin yanzu don magance rashin barci sun haɗa da takardun magani da magungunan kan-da-counter, ilimin halin mutum da halayyar dabi'a (wanda kuma aka sani da farfadowa-halayyar hali [CBT-I] don rashin barci), da adjuvant da madadin hanyoyin kwantar da hankali. Hanyar jiyya ta yau da kullun ga marasa lafiya shine a fara amfani da magungunan da ba a iya siyar da su ba sannan a yi amfani da magungunan likitanci bayan neman kulawar likita. Marasa lafiya kaɗan ne ke karɓar magani na CBT-I, wani ɓangare saboda rashin ƙwararrun likitocin da aka horar da su.

CBTI-I
CBT-I ya haɗa da jerin dabarun da ke nufin canza yanayin ɗabi'a da abubuwan tunani waɗanda ke haifar da rashin bacci, irin su wuce gona da iri da imani mara kyau game da barci. Babban abun ciki na CBT-I ya haɗa da dabarun tsara hali da barci (ƙuncewar barci da kulawar motsa jiki), hanyoyin shakatawa, ayyukan tunani da tunani (ko duka biyu) da nufin canza mummunan imani da damuwa da yawa game da rashin barci, da kuma ilimin tsabta na barci. Sauran hanyoyin shiga na mutum-jinsi kamar yarda da sadaukarwa da hankali an kuma amfani dasu don magance ingancin su, kuma akwai bukatar a nace don dogon lokaci don amfana. CBT-I magani ne na likitanci wanda ke mai da hankali kan bacci kuma yana fuskantar matsala. Yawancin likitocin lafiyar hankali (irin su masanin ilimin halayyar dan adam) ne ke jagoranta don shawarwari 4-8. Akwai hanyoyi daban-daban na aiwatarwa don CBT-I, ciki har da gajeren tsari da nau'i na rukuni, tare da haɗin gwiwar wasu ƙwararrun ƙwararrun kiwon lafiya (kamar masu aikin jinya), da kuma amfani da telemedicine ko dandamali na dijital.

A halin yanzu, ana ba da shawarar CBT-I azaman jiyya ta farko a cikin jagororin asibiti ta ƙungiyoyin ƙwararru da yawa. Gwaje-gwaje na asibiti da meta-bincike sun nuna cewa CBT-I na iya inganta ingantaccen sakamakon rahoton haƙuri. A cikin meta-bincike na waɗannan gwaje-gwajen, an gano CBT-I don haɓaka tsananin alamun rashin bacci, lokacin farawa bacci, da lokacin farkawa barci. Haɓakawa a cikin alamun rana (kamar gajiya da yanayi) da ingancin rayuwa kaɗan ne, wani ɓangare saboda amfani da jigon matakan da ba a haɓaka musamman don rashin bacci ba. Gabaɗaya, game da 60% zuwa 70% na marasa lafiya suna da amsawar asibiti, tare da raguwar maki 7 a cikin Matsakaicin Rashin bacci (ISI), wanda ke fitowa daga maki 0 ​​zuwa 28, tare da mafi girman maki yana nuna rashin bacci mai tsanani. Bayan makonni 6-8 na jiyya, game da 50% na marasa lafiya marasa barci suna samun gafara (ISI jimlar maki, <8), da 40% -45% na marasa lafiya suna samun ci gaba da gafara ga watanni 12.

A cikin shekaru goma da suka gabata, CBT-I na dijital (eCBT-I) ya zama sananne kuma yana iya ƙaddamar da babban rata tsakanin buƙatar CBT-I da samun dama. ECBT-I yana da tasiri mai kyau akan sakamakon bacci da yawa, gami da tsananin rashin bacci, ingantaccen bacci, ingancin bacci na zahiri, farkawa bayan barci, tsawon lokacin bacci, jimlar lokacin bacci, da adadin farkawa dare. Wadannan tasirin sun yi kama da waɗanda aka gani a fuska da fuska CBT-I gwaji kuma ana kiyaye su don makonni 4-48 bayan biyowa.

Yin maganin cututtuka irin su baƙin ciki da ciwo mai tsanani na iya rage alamun rashin barci, amma gaba ɗaya ba zai iya magance matsalolin rashin barci ba. Akasin haka, maganin rashin barci zai iya inganta barcin marasa lafiya tare da cututtuka, amma tasirin da ke tattare da su kansu ba daidai ba ne. Alal misali, maganin rashin barci zai iya rage alamun rashin tausayi, rage yawan abin da ya faru da kuma sake dawowa da damuwa, amma yana da ɗan tasiri akan ciwo mai tsanani.

Hanyar jiyya mai ƙima na iya taimakawa wajen magance matsalar rashin isassun albarkatun da ake buƙata don hanyoyin kwantar da hankali na al'ada da na al'ada. Ɗayan yanayin yana ba da shawarar yin amfani da ilimi, saka idanu, da hanyoyin taimakon kai a matakin farko, dijital ko rukuni na tunani da halayyar mutum a mataki na biyu, ilimin halin mutum da halayyar mutum a mataki na uku, da kuma maganin magani a matsayin ɗan gajeren lokaci a kowane mataki.

Maganin magani
A cikin shekaru 20 da suka gabata, tsarin sayan magunguna na hypnotic a Amurka ya sami canje-canje masu mahimmanci. Adadin magunguna na benzodiazepine agonists mai karɓa yana ci gaba da raguwa, yayin da adadin magungunan trazodone ke ci gaba da ƙaruwa, kodayake Hukumar Abinci da Magunguna ta Amurka (FDA) ba ta lissafta rashin bacci a matsayin alamar trazodone ba. Bugu da ƙari, an ƙaddamar da antagonists masu hana cin abinci a cikin 2014 kuma an yi amfani da su sosai.

Girman tasirin sabon magani (lokacin magani, <4 makonni) akan sakamako na farko an bayyana shi ta hanyar ma'aunin ƙima na haƙuri, gami da Indexididdigar rashin bacci, Indexididdigar Ingancin Barci na Pittsburgh, Tambayar Barci na Leeds, da Diary Diary. Girman sakamako na 0.2 ana la'akari da ƙananan, girman tasiri na 0.5 ana la'akari da matsakaici, kuma ana ɗaukar girman tasirin 0.8 babba.

Ma'auni na Beers (jerin magungunan da aka yi la'akari da rashin dacewa ga marasa lafiya masu shekaru 65 ko fiye) sun ba da shawarar guje wa amfani da wannan magani.

FDA ba ta amince da maganin don maganin rashin barci ba. Duk magungunan da aka jera a cikin tebur an rarraba su azaman Class C na ciki ta FDA ta Amurka, ban da kwayoyi masu zuwa: Triazolam da Temazepam (Class X); Clonazepam (Class D); Diphenhydramine da docetamine (class B).
1. Benzodiazepine receptor agonist class hypnotic kwayoyi
Benzodiazepine agonists receptor agonists sun hada da benzodiazepine kwayoyi da marasa benzodiazepine kwayoyi (wanda kuma aka sani da Z-class kwayoyi). Gwaje-gwaje na asibiti da meta-bincike sun nuna cewa masu karɓar masu karɓar benzodiazepine na iya rage lokacin bacci yadda ya kamata, rage farkawa bayan barci, da ɗan ƙara yawan tsawon lokacin bacci (Table 4). Dangane da rahotannin haƙuri, abubuwan da ke tattare da agonists masu karɓa na benzodiazepine sun haɗa da anterograde amnesia (<5%), sedation a rana mai zuwa (5% ~ 10%), da kuma halaye masu rikitarwa a lokacin barci kamar mafarkin rana, cin abinci, ko tuki (3% ~ 5%). Sakamakon sakamako na ƙarshe shine saboda gargaɗin akwatin baki na zolpidem, zaleplon, da escitalopram. 20% zuwa 50% na marasa lafiya suna fama da juriya na miyagun ƙwayoyi da dogaro da ilimin lissafin jiki bayan shan magani kowane dare, wanda aka bayyana azaman rashin bacci da rashin bacci.

2. Magungunan heterocyclic masu kwantar da hankali
Magungunan kwantar da hankali, gami da magungunan tricyclic irin su amitriptyline, demethylamine, da doxepin, da magungunan heterocyclic irin su olanzapine da trazodone, ana yawan ba su magunguna don magance rashin barci. Doxepin kawai (3-6 MG kowace rana, ana sha da dare) FDA ta Amurka ta amince da ita don maganin rashin barci. Shaidu na yanzu sun nuna cewa magungunan kwantar da hankali na iya haɓaka ingancin bacci gabaɗaya, ingantaccen bacci, da tsawaita tsawon lokacin bacci, amma ba su da ɗan tasiri akan tsawon lokacin bacci. Kodayake FDA ta Amurka ba ta lissafa rashin barci a matsayin alamar waɗannan magunguna ba, likitoci da marasa lafiya sukan fi son waɗannan kwayoyi saboda suna da ƙananan illa a ƙananan allurai kuma ƙwarewar asibiti ta nuna tasirin su. Abubuwan da ke haifar da illa sun haɗa da kwantar da hankali, bushe baki, jinkirin tafiyar da zuciya, hauhawar jini, da hauhawar jini.

3. Masu adawa da cin abinci
Kwayoyin da ke dauke da orexin a cikin hypothalamus na gefe suna motsa tsakiya a cikin kwakwalwar kwakwalwa da hypothalamus waɗanda ke inganta farkawa, da kuma hana ƙwayoyin cuta a cikin sassan ventral da na tsakiya na tsakiya waɗanda ke inganta barci. Akasin haka, masu hana ci abinci na iya hana tafiyar da jijiya, danne farkawa, da haɓaka bacci. Uku dual orexin antagonists antagonists (sucorexant, lemborxant, da daridorexint) an amince da su ta hanyar US FDA don maganin rashin barci. Gwaje-gwaje na asibiti suna goyan bayan ingancin su a farkon barci da kiyayewa. Abubuwan da ke haifar da cutar sun haɗa da kwantar da hankali, gajiya, da kuma mafarki mara kyau. Saboda rashi na endogenous ci hormones, wanda zai iya haifar da narcolepsy tare da cataplexy, ci hormone antagonists an contraindicated a irin wannan marasa lafiya.

4. Melatonin da melatonin agonists
Melatonin wani hormone ne wanda glandan pineal ke ɓoye a ƙarƙashin yanayin duhu da dare. Exogenous melatonin zai iya kai ga yawan jini fiye da matakan ilimin lissafi, tare da bambance-bambancen lokuta dangane da takamaiman sashi da tsari. Ba a ƙayyade adadin da ya dace na melatonin don magance rashin barci ba. Gwaje-gwajen da aka sarrafa da suka shafi manya sun nuna cewa melatonin yana da ɗan ƙaramin tasiri akan fara bacci, ba tare da kusan wani tasiri akan farkawa yayin bacci da tsawon lokacin bacci ba. Magungunan da ke ɗaure da melatonin MT1 da MT2 masu karɓa an yarda da su don maganin rashin barci mai raɗaɗi (ramelteon) da rikicewar barci na circadian (tasimelteon). Kamar melatonin, waɗannan magungunan ba su da wani tasiri a kan farkawa ko jimlar lokacin barci bayan barci. Barci da gajiya sune illolin da aka fi sani.

5. Sauran kwayoyi
Magungunan antihistamines a cikin magungunan kan-da-counter (diphenhydramine da docetamine) da magungunan magani (hydroxyzine) sune magungunan maganin rashin barci da aka fi amfani da su. Bayanan da ke goyan bayan ingancinsa yana da rauni, amma samun damar su da kuma fahimtar aminci ga marasa lafiya na iya zama dalilan shaharar su idan aka kwatanta da agonists masu karɓar benzodiazepine. Magungunan antihistamines masu kwantar da hankali na iya haifar da tashin hankali mai yawa, sakamako masu illa na anticholinergic, da kuma ƙara haɗarin lalata. Gabapentin da pregabalin ana amfani da su don magance ciwo mai tsanani kuma suma magungunan layi na farko don ciwon ƙafar ƙafa. Wadannan kwayoyi suna da tasirin kwantar da hankali, suna ƙara jinkirin barci, kuma ana amfani da su don magance rashin barci (fiye da alamomi), musamman idan suna tare da ciwo. Gajiya, bacci, dizziness, da ataxia sune illolin da aka fi sani.

Zaɓin magungunan hypnotic
Idan an zaɓi magani don magani, gajeriyar agonists masu karɓa na benzodiazepine, antagonists na orexin, ko ƙananan ƙwayoyin heterocyclic sune zaɓin farko na farko a mafi yawan yanayin asibiti. Benzodiazepine agonists receptor agonists na iya zama abin da aka fi so don marasa lafiya marasa barci tare da alamun fara barci, ƙananan marasa lafiya, da marasa lafiya waɗanda zasu buƙaci magani na gajeren lokaci (kamar rashin barci saboda matsananciyar damuwa ko lokaci-lokaci). Lokacin da ake kula da marasa lafiya da alamun da ke da alaƙa da kiyaye barci ko farkawa da wuri, tsofaffi, da waɗanda ke da matsalar amfani da kayan maye ko rashin bacci, ƙananan ƙwayoyin heterocyclic ko masu hana ci na iya zama zaɓi na farko.

Bisa ga ka'idodin Beers, jerin magungunan da ba su dace ba ga marasa lafiya masu shekaru 65 ko fiye sun haɗa da agonists masu karɓa na benzodiazepine da magungunan heterocyclic, amma ba ya haɗa da doxepin, trazodone, ko orexin antagonists. Maganin farko yakan haɗa da shan magani kowane dare har tsawon makonni 2-4, sannan a sake kimanta illa da illa. Idan ana buƙatar magani na dogon lokaci, ƙarfafa magunguna na lokaci-lokaci (sau 2-4 a mako). Ya kamata a jagoranci marasa lafiya don shan magani minti 15-30 kafin lokacin kwanta barci. Bayan magani na dogon lokaci, wasu marasa lafiya na iya haɓaka dogaro da miyagun ƙwayoyi, musamman lokacin amfani da agonists masu karɓa na benzodiazepine. Bayan amfani na dogon lokaci, ragi da aka tsara (kamar raguwar 25% a kowane mako) na iya taimakawa rage ko dakatar da magungunan hypnotic.

Zaɓin tsakanin hanyoyin haɗin gwiwa da monotherapy
Wasu 'yan data kasance kai da kai binciken kwatancen sun nuna cewa a cikin ɗan gajeren lokaci (makonni 4-8), CBT-I da magungunan hypnotic (mafi yawan magungunan Z-class) suna da irin wannan tasirin akan inganta ci gaba da bacci, amma maganin miyagun ƙwayoyi na iya ƙara yawan tsawon lokacin bacci idan aka kwatanta da CBT-I. Idan aka kwatanta da yin amfani da CBT-I kadai, haɗin haɗin gwiwa zai iya inganta barci da sauri, amma wannan amfani a hankali yana raguwa a cikin mako na hudu ko na biyar na jiyya. Bugu da ƙari, idan aka kwatanta da magani ko haɗin haɗin gwiwa, ta yin amfani da CBT-I kadai na iya inganta barci mai tsayi. Idan akwai wata hanyar da ta fi dacewa ta shan magungunan barci, bin wasu marasa lafiya da shawarar ɗabi'a na iya raguwa.