失眠與睡眠疾病

長期失眠可能導致日間功能缺損，容易因為嗜睡造成意外，同時影響生活品質、甚至造成罹患精神疾病的風險。根據行政院主計處所發布民國九十年國人健康概況與健康檢查情形，針對台灣地區十五歲以上人口在應用「失眠自我評估表」的主觀睡眠狀況進行調查發現，有一成以上的人認為自己睡眠品質不佳，而根據國外研究發現，在所有人口當中，約1/4甚至高達一半以上的人有睡眠方面的困擾。因此如何幫助這些有睡眠障礙的病人，是我們醫師努力的目標。

睡眠疾病的分類： 國際睡眠疾患分類將睡眠疾病分為四大類，分別為：

1. 睡眠異常 (Dyssomnia)：凡是引起睡眠啟動及維持困難，或過度嗜睡的疾病，均可歸屬此類。這類疾病又以它發生的原因分成幾類： (1)內因性：因自己體內因素造成的睡眠障礙，像是睡眠呼吸暫停症候群(sleep apnea syndrome)、腿部不寧症(Restless legs syndrome)，或是昏睡症(narcolepsy)。(2)外因性：因外在因素造成的睡眠障礙，像睡眠習慣不好，或睡眠環境不良造成的失眠。(3)生物時鐘失調性：像時差或值班造成生物時鐘失調而引起失眠。
2. 異睡症(Parasomnia)：凡睡眠疾病，本身不會造成睡眠過多或者過少，但是會使病人產生生理的不適者，都歸入此類。如夢遊、說夢話、尿床、磨牙、惡夢驚醒(夢魘)、夜驚等。
3. 與內科或精神科有關的睡眠疾病(Sleep Disorders Associated with Medical/Psychiatric Disorders)：有許多病人是因內科或精神神經疾病而產生睡眠障礙，例如有許多人會因為憂鬱症、焦慮症或慢性病纏身而失眠。這類屬於次發性的睡眠障礙醫師可經過詳細問診及病人病史加以排除。
4. 待確認的睡眠疾病(Proposed sleep disorder)：包含一些疾病推想與睡眠問題有關，但仍然缺乏直接證據，例如有許多女性會在月經周期前後、停經後或懷孕時合併睡眠障礙，睡眠當中引起喉部痙攣、嗆咳等 。

International Classification of Sleep Disorders
國際睡眠疾患分類

1. 睡眠異常 (Dyssomnias)

(A) Intrinsic sleep disorders

1. Psychophysiological insomnia
2. Sleep state misperception
3. Idiopathic insomnia
4. Narcolepsy
5. Recurrent hypersomnia
6. Idiopathic hypersomnia
7. Posttraumatic hypersomnia
8. Obstructive sleep apnea syndrome
9. Central sleep apnea syndrome
10. Central alveolar hypoventilation syndrome
11. Periodic limb movement disorder
12. Restless legs syndrome
13. Intrinsic sleep disorder NOS

(B) Extrinsic sleep disorders

1. Inadequate sleep hygiene
2. Environmental sleep disorder
3. Altitude insomnia
4. Adjustment sleep disorder
5. Insufficient sleep syndrome
6. Limit-setting sleep disorder
7. Sleep-onset association disorder
8. Food allergy insomnia
9. Nocturnal eating (drinking) syndrome
10. Hypnotic-dependent sleep disorder
11. Stimulant-dependent sleep disorder
12. Alcohol-dependent sleep disorder
13. Toxin-induced sleep disorder
14. Extrinsic sleep disorder NOS

(C) Circadian rhythm sleep disorders

1. Time zone change (jet lag) syndrome
2. Shift work sleep disorder
3. Irregular sleep-wake pattern
4. Delayed sleep phase syndrome
5. Advanced sleep phase syndrome
6. Non-24 hour sleep-wake disorder
7. Circadian rhythm sleep disorder NOS

2. 異睡症(Parasomnias)

(A) Arousal disorders

1. Confusional arousals
2. Sleepwalking
3. Sleep terrors

(B) Sleep-wake transition disorders

1. Rhythmic Movement Disorder
2. Sleep Starts
3. Sleep Talking
4. Nocturnal Leg Cramps

(C) Parasomnias usually associated with REM sleep

1. Nightmares
2. Sleep Paralysis
3. Impaired Sleep-Related Penile Erections
4. Sleep-Related Painful Erections
5. REM Sleep-Related Sinus Arrest
6. REM Sleep Behavior Disorder

(D) Other Parasomnias

1. Sleep Bruxism
2. Sleep Enuresis
3. Sleep-Related Abnormal Swallowing Syndrome
4. Nocturnal Paroxysmal Dystonia
5. Sudden Unexplained Nocturnal Death Syndrome
6. Primary Snoring
7. Infant Sleep Apnea
8. Congenital Central Hypoventilation Syndrome
9. Sudden Infant Death Syndrome
10. Benign Neonatal Sleep Myoclonus
11. Other Parasomnia NOS

3. Sleep Disorders Associated with Medical/Psychiatric Disorders

(A) Associated with Mental Disorders

1. Psychoses
2. Mood Disorders
3. Anxiety Disorder
4. Panic Disorder
5. Alcoholism

(B) Associated with Neurological Disorders

1. Cerebral Degenerative Disorder
2. Dementia
3. Parkinsonism
4. Fatal Familial Insomnia
5. Sleep-Related Epilepsy
6. Electrical Status Epilepticus of Sleep
7. Sleep-Related Headaches

(C) Associated with other medical disorders

1. Sleeping Sickness
2. Nocturnal Cardiac Ischemia
3. Chronic Obstructive Pulmonary Disease
4. Sleep-Related Asthma
5. Sleep-Related Gastroesophageal Reflux
6. Peptic Ulcer Disease
7. Fibrositis Syndrome

4. Proposed sleep disorders

1. Short Sleeper
2. Long Sleeper
3. Subwakefulness Syndrome
4. Fragmentary Myoclonus
5. Sleep Hyperhidrosis
6. Menstrual-Associated Sleep Disorder
7. Pregnancy-Associated Sleep Disorder
8. Terrifying Hypnagogic Hallucinations
9. Sleep-Related Neurogenic Tachypnea
10. Sleep-Related Laryngospasm
11. Sleep Choking Syndrome