Pharmacological and non pharmacological options in therapy of insomnia

Nesanica je poremećaj koji se javlja kod velikog broja ljudi i može imati puno različitih uzroka. Kratkotrajne (akutne) nesanice su uglavnom posljedice stresnih situacija koje osoba proživljava u svom životu i obično nestaju kada se izvor stresa ukloni. Kronične nesanice imaju razne uzroke i često su povezane sa psihološkihm problemima. Liječenje nesanice, ovisno o težini, uzroku i samom pacijentu, može biti jednostavno ili jako komplicirano. Kratkotrajna nesanica obično ne zahtjeva posebnu terapiju, ili ako je ona potrebna onda nije dugotrajna i obično se ne javljaju komplikacije s njezinom primjenom. Kronična nesanica ima raznolike uzroke i njezina terapija je obično dugotrajna. Farmakoterapijske mogućnosti liječenja nesanice se uglavnom baziraju na primjeni agonista benzodiazepinskih receptora (benzodiazepini i Z-lijekovi), ali postoje i druge opcije, poput antidepresiva, ramelteona, melatonina,valerijane, H1-antihistaminika i L-triptofana. Agonisti benzodiazepinskih receptora pokazuju dobre rezultate pri skraćivanju vremena usnivanja, trajanju spavanja i kvaliteti sna. Problemi s primjenom agonista benzodiazepinskih receptora predstavljaju dnevni simptomi (umor, mamurluk, nemir) i mogućnost razvoja tolerancije i ovisnosti nakon dugotrajne primjene. Nefarmakološke mjere su različite metode psihološko bihevioralne terapije. Njihova prednost je što pokazuju dobru učikovitost pri skraćivanju vremena usnivanja, trajanju sna i kvaliteti sna, i sigurne su za primjenu kroz dulje vrijeme. Problem s ovim oblikom terapije je što je ona skupa, zahtjeva posebno educirane stručnjake, i ne pokazuje trenutno djelovanje na simptome nesanice. Kombinirana terapija ima sve prednosti psihološko bihevioralne terapije, uz izbjegavanje nuspojava koje se javljaju sa farmakološkim mjerama terapije. Alternativne metode poput akupunkture, akupresure, yoge i tai-chi-a predstavljaju mogućnost terapije nesanice, ali ne postoji veliki broj istraživanja ovih mogućnosti terapije nesanice i istraživanja koja su provedena pokazuju neujednačene rezultate. Pri odabiru terapije treba imati na umu kako ona može biti dugotrajna i stoga treba najviše paziti na individualnost svakog pacijenta kako bi se odredile mogućnosti terapije koje su najbolje, ali i dostupne pacijentu.Insomnia is a disorder which occurs in a large number of people, it can have a lot of different causes. Short lasting (acute) insomnias are mostly results of stressful situations which a person experiences in his or hers life, and they usually end when the source of the stress is removed. Chronic insomias have different causes and they are frequently associated with psyhological problems. Treatment of insomnia, depending on the severity, cause and the individual patient, can be simple or very complicated. Acute insomnia usually doesn't require special therapy, or if therapy is needed it is not long lasting and usually it doesn't show severe complications with it's use. Chronic insomnia can have different causes and it's therapy is usually long lasting. Pharmacotherapeutic possibilities of insomia treatment are usually based on administration of benzodiazepine receptor antagonists (benzodiazepines and Z-drugs), but there are other options, such as antidepressants, ramelteon, melatonin, valerian, H1-antihistaminics and L-tryptophan. Benzodiazepine receptor antagonists show good results in shortening sleep onset latency, sleep duaration and sleep quality. Problems with the use of bendodiazepine receptor agonists are shown in daytime simptoms (fatigue, hangovers, restlessness) and the possibility of tolerance and dependence after longer use. Non pharmacological treatment are thought of as different methods of psyhological bihevioral therapy. The advantage here is that they show good results in shortening sleep onset latency, sleep duaration and sleep quality, and they are safe as a long term therapy option. The problem with this type of therapy is that it is expensive, it requiers specially trained experts and it doesn't show immediate results. Combined therapy has all the advantages of psyhological bihevioral therapy, with avoiding side effects which occure with pharmacological treatments. Alternative methods, such as acupuncture, acupressure, yoga and tay-chi are other methods of insomnia treatment, but there are not a lot of studies in this field, and the ones that have been made have inconsistent results. When choosing a therapy option, one should always have in mind that it can be long lasting, and therefore the individuality of each patient should get the most attention, so the best possible, but affordable option can be determined