Zolpidem Tartrate

氯硝西泮被称为“最强安眠药”，是我国管制的二类精神药品，具有抗焦虑、催眠及中枢性肌肉松弛作用。氯硝西泮副作用较大，且具有明显的成瘾性和依赖性。氯硝西泮作用于中枢神经系统的苯二氮卓受体（BZR），加强中枢抑制性神经递质 γ-氨基丁酸（GABA）与 GABAA 受体的结合，促进氯通道开放，细胞过极化，增强 GABA 能神经元所介导的突触抑制，使神经元的兴奋性降低。临床可用于治疗如下疾病：癫痫发作、惊恐障碍、焦虑状态和失眠。国内外指南推荐可点击图片查看氯硝西泮常见不良反应可点击图片查看患者用药注意1.患者应避免进行需要精神警觉性或协调性的活动，直至药效得以实现2.建议长期用药的患者勿突然停药，以避免出现戒断症状3.患者服用该药时勿饮酒特殊人群用药注意事项老年人用药：老年人对长效苯二氮䓬类安眠药如地西泮、氯硝西泮等敏感性高，代谢慢，更易发生宿醉效应，故该类药物在老年人中需谨慎应用；孕妇用药：根据FDA分级，苯二氮䓬类药物中艾司唑仑为X级，硝西泮为C级，其他均为D及；非苯二氮䓬类药物中，扎来普隆、唑吡坦、佐匹克隆及右佐匹克隆均为C级。孕妇用药需谨慎。综上，氯硝西泮属于中效苯二氮卓类镇静催眠药，过去临床上常用其治疗失眠症，尤其适用于睡眠维持障碍的患者，但由于其不良反应多且发生率高，目前临床上很少用其治疗失眠症，如今，氯硝西泮在临床上主要用于控制各型癫痫发作，因此，开具氯硝西泮时应结合患者情况进行评估是否试用。参考资料：[1] 氯硝西泮说明书[2] 中华医学会神经病学分会, 中华医学会神经病学分会睡眠障碍学组, 中华医学会神经病学分会神经心理与行为神经病学学组. 中国成人失眠伴抑郁焦虑诊治专家共识 [J].  中华神经科杂志,2020,53(08)：564-574[3] 中华医学会神经病学分会睡眠障碍学组. 中国快速眼球运动睡眠期行为障碍诊断与治疗专家共识 [J].  中华神经科杂志,2017,50(8)：567-571.[4] 中华预防医学会更年期保健分会, 中国人体健康科技促进会妇科内分泌和生育力促进专委会, 北京中西医结合学会更年期专业委员会. 绝经相关失眠临床管理中国专家共识 [J].  中国全科医学,2023,26(24)：2951-2958.[5] 中国睡眠研究会. 中国失眠症诊断和治疗指南 [J].  中华医学杂志,2017,97(24)：1844-1856.[6] 中国医师协会全科医师分会双心学组, 心血管疾病合并失眠诊疗中国专家共识组. 心血管疾病合并失眠诊疗中国专家共识 [J]. 中华内科杂志,2017,56(4)：310-315.[7]《安眠药的分类及选择丨协和神经科基本功》，作者北京协和医院 史佳宇编辑 | B.O如有侵权请联络梅斯医学管理员王晓亮@梅斯医学（微信号：wxid_vaci8ymoetvp22）“鬼压床”究竟是怎么回事？经常被“压”的人要小心了！注意！这10个常见焦虑症状不可忽视，你的胃可能在诉说......警惕！这类家属可能会对精神病患者造成严重影响！↓点击下方“阅读原文”，下载梅斯医学APP吧！

A new review of research evidence has explored the key differences in how women and men sleep, variations in their body clocks, and how this affects their metabolism. A new review of research evidence has explored the key differences in how women and men sleep, variations in their body clocks, and how this affects their metabolism. Published in Sleep Medicine Reviews, the paper highlights the crucial role sex plays in understanding these factors and suggests a person's biological sex should be considered when treating sleep, circadian rhythm and metabolic disorders. Differences in sleep The review found women rate their sleep quality lower than men's and report more fluctuations in their quality of sleep, corresponding to changes throughout the menstrual cycle. "Lower sleep quality is associated with anxiety and depressive disorders, which are twice as common in women as in men," says Dr Sarah L. Chellappa from the University of Southampton and senior author of the paper. "Women are also more likely than men to be diagnosed with insomnia, although the reasons are not entirely clear. Recognising and comprehending sex differences in sleep and circadian rhythms is essential for tailoring approaches and treatment strategies for sleep disorders and associated mental health conditions." The paper's authors also found women have a 25 to 50 per cent higher likelihood of developing restless legs syndrome and are up to four times as likely to develop sleep-related eating disorder, where people eat repeatedly during the night. Meanwhile, men are three times more likely to be diagnosed with obstructive sleep apnoea (OSA). OSA manifests differently in women and men, which might explain this disparity. OSA is associated with a heightened risk of heart failure in women, but not men. Sleep lab studies found women sleep more than men, spending around 8 minutes longer in non-REM (Rapid Eye Movement) sleep, where brain activity slows down. While the time we spend in NREM declines with age, this decline is more substantial in older men. Women also entered REM sleep, characterised by high levels of brain activity and vivid dreaming, earlier than men. Variations in body clocks The team of all women researchers from the University of Southampton in the UK, and Stanford University and Harvard University in the United States, found differences between the sexes are also present in our circadian rhythms. They found melatonin, a hormone that helps with the timing of circadian rhythms and sleep, is secreted earlier in women than men. Core body temperature, which is at its highest before sleep and its lowest a few hours before waking, follows a similar pattern, reaching its peak earlier in women than in men. Corresponding to these findings, other studies suggest women's intrinsic circadian periods are shorter than men's by around six minutes. Dr Renske Lok from Stanford University, who led the review, says: "While this difference may be small, it is significant. The misalignment between the central body clock and the sleep/wake cycle is approximately five times larger in women than in men. Imagine if someone's watch was consistently running six minutes faster or slower. Over the course of days, weeks, and months, this difference can lead to a noticeable misalignment between the internal clock and external cues, such as light and darkness. "Disruptions in circadian rhythms have been linked to various health problems, including sleep disorders, mood disorders and impaired cognitive function. Even minor differences in circadian periods can have significant implications for overall health and well-being." Men tend to be later chronotypes, preferring to go to bed and wake up later than women. This may lead to social jet lag, where their circadian rhythm doesn't align with social demands, like work. They also have less consistent rest-activity schedules than women on a day-to-day basis. Impact on metabolism The research team also investigated if the global increase in obesity might be partially related to people not getting enough sleep -- with 30 per cent of 30- to 64-year-olds sleeping less than six hours a night in the United States, with similar numbers in Europe. There were big differences between how women's and men's brains responded to pictures of food after sleep deprivation. Brain networks associated with cognitive (decision making) and affective (emotional) processes were twice as active in women than in men. Another study found women had a 1.5 times higher activation in the limbic region (involved in emotion processing, memory formation, and behavioural regulation) in response to images of sweet food compared to men. Despite this difference in brain activity, men tend to overeat more than women in response to sleep loss. Another study found more fragmented sleep, taking longer to get to sleep, and spending more time in bed trying to get to sleep were only associated with more hunger in men. Both women and men nightshift workers are more likely to develop type 2 diabetes, but this risk is higher in men. Sixty-six per cent of women nightshift workers experienced emotional eating and another study suggests they are around 1.5 times more likely to be overweight or obese compared to women working day shifts. The researchers also found emerging evidence on how women and men respond differently to treatments for sleep and circadian disorders. For example, weight loss was more successful in treating women with OSA than men, while women prescribed zolpidem (an insomnia medication) may require a lower dosage than men to avoid lingering sleepiness the next morning. Dr Chellappa added: "Most of sleep and circadian interventions are a newly emerging field with limited research on sex differences. As we understand more about how women and men sleep, differences in their circadian rhythms and how these affect their metabolism, we can move towards more precise and personalised healthcare which enhances the likelihood of positive outcomes." The research was funded by the Alexander Von Humboldt Foundation, the US Department of Defense and the National Institute of Health.