Sleep is an important function for all living beings, in fact the absence of sleep causes problems that affect the daily life of the subject. There are many pathologies connected to sleep, these are classified in the ICSD-3 (International Classification of Sleep Disorders) which mainly identifies 7 categories: insomnia is the most common disorder. Insomnia is characterized by difficulty falling asleep and maintaining sleep, multiple awakenings during the night, early awakenings in the morning and drowsiness during the day. Insomnia can be classified according to various criteria: if we pay attention to the associations that can occur between the various pathologies then we have the distinction between primary (which arises independently of other disorders) and secondary (when it is associated with other diseases) insomnia. Among the primary insomnia we mention the psychophysiological insomnia which is the most common form and it is usually caused by cognitive and behavioral factors. It is therefore essential not to underestimate this condition and to know how to identify and treat it in the right way because sometimes insomnia is caused by bad behavior. To choose the right treatment for the treatment of this disorder, it is necessary to investigate what is the cause of insomnia and what are the factors related to it. There are various approaches to solving this problem: the simplest techniques are behavioral and based on a psychological approach; however, there are also various pharmacological approaches based on the use of hypnotic and anxiolytic medicines. Benzodiazepines are the first choice drugs for the treatment of this disorder, however, they have a lot of side effects and they can cause tolerance and dependence if used for a long time: the ideal treatment in fact it should not exceed three / four weeks. Finally, Z drugs offer hypnotic efficacy similar to the benzodiazepines but they cause a lower risk of tolerance and sleepiness the following day. The purpose of this thesis is to underline the importance of the combination of pharmacological and psychological treatment for the treatment of insomnia. The advantage of psychological treatment is based on changing those beliefs and attitudes of the patient that cause and extend the factors that trigger insomnia. Cognitive behavioral therapy CBT-I is the non-pharmacological therapy used for the treatment of psychophysiological insomnia. This treatment uses various procedures carried out by a psychologist to improve sleep quality and also maintenance. CBT-I is based on 8 meetings in which the patient initially completes questionnaires and makes specific tests evaluated by the psychologist who finally values the right treatment. The treatment may involves the use of cognitive, behavioral techniques and also the use of sleep hygiene rehabilitation. Sometimes patients go to the pharmacy asking immediately for drugs to be able to sleep. The pharmacist plays a fundamental role in choosing the right treatment. In fact, he must understand (by asking questions) what is the reason why the patient has problem in sleeping and he must gives the necessary drug, recommends other therapies or refers the patient to a psychological evaluation.
Il sonno è una funzione fondamentale per tutti gli esseri viventi, infatti l’assenza di questo può causare problemi che si ripercuotono sulla vita quotidiana del soggetto. Moltissime sono le patologie che colpiscono il sonno, sono classificate nell’ICSD-3 (Classificazione Internazionale dei Disturbi del Sonno) che individua principalmente 7 categorie, fra questa l'insonnia. Definita come mancanza di sonno, l’insonnia è caratterizzata da difficoltà nell’addormentamento e nel mantenimento del sonno, da più risvegli durante la notte, da risvegli precoci la mattina e da sonnolenza durante tutto il giorno. L’insonnia può essere classificata in base a vari criteri: se prendiamo in considerazione le associazioni che si possono avere tra le varie patologie allora abbiamo la distinzione in insonnia primaria (che insorge indipendentemente da altri disturbi) e secondaria (quando è associata ad altre patologie). Fra le insonnie primarie ricordiamo l’insonnia psicofisiologica che è la forma più comune ed è solitamente causata da fattori cognitivi e comportamentali. È fondamentale quindi non sottostimare questa condizione e saperla identificare e curare nel modo giusto perché molto spesso essa risulta essere l’effetto della mancata osservanza di quelle regole che caratterizzano una buona igiene del sonno, suggerita anche solo dal buon senso comune. Per scegliere il giusto trattamento per la cura di questo disturbo si deve indagare su quale sia la causa dell’insonnia e quali siano i fattori ad essa correlati. Esistono vari approcci per la risoluzione di questo problema e tra queste le terapie basate su un approccio psicologico si avvalgono di tecniche comportamentali, cognitive e di igiene del sonno; esistono però anche vari approcci farmacologici che puntano sull’utilizzo di medicinali ipnotici e ansiolitici. I farmaci di prima scelta per la cura di questo disturbo sono le benzodiazepine. Ma bisogna far fronte, come per ogni farmaco, ai noti effetti collaterali ma soprattutto al rischio di sviluppare tolleranza e dipendenza se usate per un periodo di tempo elevato: il trattamento ideale infatti non dovrebbe superare le tre/quattro settimane. I farmaci Z infine offrono un’efficacia ipnotica simile a quella delle benzodiazepine ma causano un minor rischio di tolleranza e di sonnolenza il giorno successivo. Lo scopo di questa tesi è sottolineare l’importanza della combinazione tra un trattamento farmacologico e psicologico per la cura dell’insonnia. Il vantaggio del trattamento psicologico si basa sul cambiare quelle convinzioni e quegli atteggiamenti del paziente che, da soli o insieme ad alcune abitudini comportamentali, causano ed estendono i fattori che scatenano l’insonnia. La terapia cognitivo-comportamentale CBT-I è la terapia non farmacologica utilizzata per la cura dell’insonnia psicofisiologica. Questa utilizza varie procedure veicolate da uno psicologo per migliorare la qualità del sonno e anche il mantenimento. La CBT-I si basa su un ciclo di circa 8 incontri in cui il paziente inizialmente compila dei questionari ed effettua Test specialistici che vengono poi valutati dallo psicologo e restituiti con una diagnosi operativa di trattamento; il trattamento può prevedere l’impiego di tecniche cognitive, comportamentali o di rieducazione all’igiene del sonno. Molto spesso i pazienti si recano in farmacia chiedendo immediatamente dei farmaci per riuscire a dormire. Il farmacista ha quindi un ruolo fondamentale nella scelta del giusto trattamento. Infatti deve prima capire (facendo delle domande) quale sia il motivo per cui il paziente ha difficoltà a dormire e in seguito alle giuste valutazioni deve dispensare il farmaco, consigliare altre terapie o indirizzare il paziente ad una valutazione psicologica.
La gestione dell'insonnia: farmacoterapia e psicoterapia
LUCENTINI, ANNA
2019/2020
Abstract
Sleep is an important function for all living beings, in fact the absence of sleep causes problems that affect the daily life of the subject. There are many pathologies connected to sleep, these are classified in the ICSD-3 (International Classification of Sleep Disorders) which mainly identifies 7 categories: insomnia is the most common disorder. Insomnia is characterized by difficulty falling asleep and maintaining sleep, multiple awakenings during the night, early awakenings in the morning and drowsiness during the day. Insomnia can be classified according to various criteria: if we pay attention to the associations that can occur between the various pathologies then we have the distinction between primary (which arises independently of other disorders) and secondary (when it is associated with other diseases) insomnia. Among the primary insomnia we mention the psychophysiological insomnia which is the most common form and it is usually caused by cognitive and behavioral factors. It is therefore essential not to underestimate this condition and to know how to identify and treat it in the right way because sometimes insomnia is caused by bad behavior. To choose the right treatment for the treatment of this disorder, it is necessary to investigate what is the cause of insomnia and what are the factors related to it. There are various approaches to solving this problem: the simplest techniques are behavioral and based on a psychological approach; however, there are also various pharmacological approaches based on the use of hypnotic and anxiolytic medicines. Benzodiazepines are the first choice drugs for the treatment of this disorder, however, they have a lot of side effects and they can cause tolerance and dependence if used for a long time: the ideal treatment in fact it should not exceed three / four weeks. Finally, Z drugs offer hypnotic efficacy similar to the benzodiazepines but they cause a lower risk of tolerance and sleepiness the following day. The purpose of this thesis is to underline the importance of the combination of pharmacological and psychological treatment for the treatment of insomnia. The advantage of psychological treatment is based on changing those beliefs and attitudes of the patient that cause and extend the factors that trigger insomnia. Cognitive behavioral therapy CBT-I is the non-pharmacological therapy used for the treatment of psychophysiological insomnia. This treatment uses various procedures carried out by a psychologist to improve sleep quality and also maintenance. CBT-I is based on 8 meetings in which the patient initially completes questionnaires and makes specific tests evaluated by the psychologist who finally values the right treatment. The treatment may involves the use of cognitive, behavioral techniques and also the use of sleep hygiene rehabilitation. Sometimes patients go to the pharmacy asking immediately for drugs to be able to sleep. The pharmacist plays a fundamental role in choosing the right treatment. In fact, he must understand (by asking questions) what is the reason why the patient has problem in sleeping and he must gives the necessary drug, recommends other therapies or refers the patient to a psychological evaluation.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/11692