精神医学60巻9号

2018年09月発行

特集 不眠症の治療と睡眠薬

不眠症の長期経過を考える

著者： 井上雄一¹

所属機関： ¹東京医科大学睡眠学講座

ページ範囲：P.965 - P.972

はじめに
　不眠症は，かつては比較的病的意義の低いcommon diseaseと捉えられがちだったが，精神疾患(特にうつ病や気分障害)や生活習慣病発現のリスク要因になるばかりでなく，不眠症治療がこれらの治療管理にもきわめて重要な意義を持つこと，治療の第一選択薬とされてきたベンゾジアゼピン類ないしそのアゴニスト(BZDs)の多剤併用と長期使用が問題視されるようになったことなどから，その治療の適正化の重要性が認識されるようになった。すなわち，治療開始のタイミング，症状構造と背景疾患に配慮した治療手技の選択，維持療法のあり方，副作用への対策，再発予防を視野に入れた治療終結のあり方などが，今日的な課題となっている。本稿では，不眠症の自然経過や予後，再発リスク，各種治療の予後に及ぼす影響について，現在までに得られている研究成果を述べるとともに，今後の課題について考えてみたい。

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