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躺下就睡不着，已经好几个月了怎么办

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一周三晚以上、拖了三个月以上，先做失眠的认知行为治疗，别一上来就长期吃安眠药。做完入睡平均快约 19 分钟，半夜醒着少约 26 分钟，12 个月后效果还在。

这里不保证什么

打鼾很响、有人看见你睡着时憋气、白天困到开车都想睡，先去做睡眠监测查呼吸暂停；安眠药别自己长期吃。

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长期失眠（一周三晚以上、拖了三个月以上）先做失眠的认知行为治疗，别一上来就长期吃安眠药

做完这套治疗，入睡平均快约 19 分钟，半夜醒着的时间少约 26 分钟。效果会慢慢变弱，但 12 个月后还在。网上的自助课程和当面做的效果差不多。安眠药对 60 岁以上的人帮助小，每 6 人吃药就有 1 人出副作用，每 13 人才有 1 人睡好。

  • 先自己试刺激控制：困了才上床，躺一阵睡不着就起来
  • 床只用来睡觉，每天同一时间起床，白天不打盹
  • 按 6 到 8 周去睡眠门诊或网上的自助课程做完一整套

坑睡眠限制那一步要把躺床时间压短，头几周白天会更困，开车和操作机器的人要慎用，最好在医生跟进下做。

成本：去医院的睡眠门诊、精神科或心理科做，要花挂号费和治疗费。网上的自助课程便宜得多。一个疗程一般 6 到 8 周，每天要记睡眠日记。自己就能先做的是刺激控制：困了才上床，躺着睡不着就起床。床只用来睡觉和性生活，每天同一时间起床，白天不打盹。难在睡眠限制那一步：头几周要把躺床时间压短，白天会更困。第 3 节 · 不要浪费精力

出处

国家卫生健康委办公厅 (2020). 关于印发精神障碍诊疗规范（2020 年版）的通知（国卫办医函〔2020〕945 号），附件第十二章第二节「失眠障碍」. <https://www.nhc.gov.cn/yzygj/c100068/202012/b4305ace9e14440792eb76d29602c88a.shtml>；Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 165(2):125-133. <https://doi.org/10.7326/M15-2175>；Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of Internal Medicine, 163(3):191-204. <https://doi.org/10.7326/M14-2841>；van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A (2019). Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies. Sleep Medicine Reviews, 48:101208. <https://doi.org/10.1016/j.smrv.2019.08.002>；Zachariae R, Lyby MS, Ritterband LM, O'Toole MS (2016). Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 30:1-10. <https://doi.org/10.1016/j.smrv.2015.10.004>；Espie CA, Emsley R, Kyle SD, 等 (2019). Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial. JAMA Psychiatry, 76(1):21-30. <https://doi.org/10.1001/jamapsychiatry.2018.2745>；Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331(7526):1169. <https://doi.org/10.1136/bmj.38623.768588.47>；Edinger JD, Arnedt JT, Bertisch SM, 等 (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2):255-262. <https://doi.org/10.5664/jcsm.8986>

打鼾很响、有人看见你睡着时憋气、白天困到开车都想睡的，去医院做睡眠监测查睡眠呼吸暂停，中重度的夜里戴呼吸机

睡眠呼吸暂停是睡着后呼吸一阵阵停住或变浅，人会憋醒，白天就犯困。戴呼吸机后，白天的困劲明显减轻，开车出事少约七成。但试验没看出它能防心脏病、能让人少死，戴它是为了白天清醒。

  • 先去睡眠门诊、呼吸科或耳鼻喉科，说清打鼾和憋气的情况
  • 做一晚睡眠监测，在医院睡或把仪器借回家
  • 确诊中重度就配呼吸机，每晚戴，先戴够时间再谈舒适

坑这一条有争议：试验没看出呼吸机能防心脏病、能让人少死，戴它是为了白天清醒；不打鼾、白天不困的不必专门去查。

成本：先去医院的睡眠门诊、呼吸科或耳鼻喉科。确诊要做一晚睡眠监测，在医院睡，或者把仪器借回家戴着睡。要戴呼吸机的，机器一般得自己买，是一笔不小的钱。难在坚持：每晚都要戴着面罩睡，头几周不习惯，不少人戴几个小时就摘了。第 3 节 · 不要浪费精力

出处

Kapur VK, Auckley DH, Chowdhuri S, 等 (2017). Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(3):479-504. <https://doi.org/10.5664/jcsm.6506>；Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG (2019). Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. Journal of Clinical Sleep Medicine, 15(2):301-334. <https://doi.org/10.5664/jcsm.7638>；Tregear S, Reston J, Schoelles K, Phillips B (2010). Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. Sleep, 33(10):1373-1380. <https://doi.org/10.1093/sleep/33.10.1373>；Tregear S, Reston J, Schoelles K, Phillips B (2009). Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. Journal of Clinical Sleep Medicine, 5(6):573-581. <https://pubmed.ncbi.nlm.nih.gov/20465027/>；McEvoy RD, Antic NA, Heeley E, 等 (2016). CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea. New England Journal of Medicine, 375(10):919-931. <https://doi.org/10.1056/NEJMoa1606599>；Yu J, Zhou Z, McEvoy RD, 等 (2017). Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis. JAMA, 318(2):156-166. <https://doi.org/10.1001/jama.2017.7967>；Benjafield AV, Ayas NT, Eastwood PR, 等 (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. The Lancet Respiratory Medicine, 7(8):687-698. <https://doi.org/10.1016/S2213-2600(19)30198-5>；US Preventive Services Task Force (2022). Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement. JAMA, 328(19):1945-1950. <https://doi.org/10.1001/jama.2022.20304>

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