El ukuqwasha kanye izinkinga zokulala Sebephenduke ekubeni yinto elula yokucasula ebusuku baya ekubeni kubhekwa njengenkinga yangempela yezempilo yomphakathi. Inani elikhulayo lezifundo libonisa ukuthi ukulala kabi akugcini nje ngokusishiya sikhathele futhi sicasukile, kodwa futhi kuhlotshaniswa nengozi ephezulu yokuba umfutho wegazi ophakeme, ukuhlaselwa yinhliziyo, isifo sohlangothi kanye nokwehluleka kwenhliziyoInhliziyo, ubuchopho, ukwakheka kwezakhi zomzimba kanye nesimo sengqondo konke kukhokha intengo yokungalali ebusuku.
Eminyakeni yamuva nje, izifundo ezahlukahlukene bezihlanganisa okutholakele: ubude kanye nekhwalithi yokulala, ukuqwasha, i-obstructive sleep apnea, kanye nezinye izifo ezifana i-restless legs syndrome Zihlobene nochungechunge lwezinguquko zezinto eziphilayo—ukusebenza okuzwelana, ukuvuvukala kwesistimu, izinguquko zamahomoni kanye nokuguqulwa kwe-metabolic—ezisekela ukubonakala nokuqhubeka kwe- izifo zenhliziyo (CVD)Ake sibukeze ngokuningiliziwe lokho okwaziwayo namuhla, ukuthi yiziphi izindlela ezihilelekile, nokuthi yini esingayenza sisehhovisi likadokotela nasekhaya ukuze sivikele kokubili ubuthongo kanye nenhliziyo.
Ukuqwasha: ukuthi kuyini, kuvame kangakanani, nokuthi kuhlukaniswa kanjani
Ukungalali kuchazwa njenge- ukunganeliseki okuqhubekayo ngobuningi noma ikhwalithi yokulalaLokhu kuvame ukuhambisana nobunzima bokulala, ukuhlala ulele, noma ukuvuka ekuseni kakhulu, kanye nomuzwa wokungakwazi ukuphinda ulale. Ukuze ukuqwasha kubhekwe njengokubalulekile emtholampilo, lezi zinkinga kumele futhi zibe nemiphumela emini: ukukhathala, ukozela, ukucasuka, ubunzima bokugxilisa ingqondo, noma ukusebenza kabi.
Izinkinga zokulala zivame kakhulu kubantu abaningi, futhi ukungakwazi ukulala kuyinkosi: ngokwezincazelo ezahlukene, Ukusabalala kuphakathi kuka-5% no-50%Uma sicabangela izimpawu zasebusuku kuphela (izinkinga zokuqala noma zokugcina ubuthongo), kulinganiselwa ukuthi cishe ingxenye eyodwa kwezintathu yabantu Wonke umuntu uyabhekana nazo ngesinye isikhathi. ESpain, kulinganiselwa ukuthi cishe oyedwa kwabahlanu Unenkinga yokungalali.
Abantu abanokuqwasha bavame ukuba nezimpawu eziningi izifo ezihambisana nezokwelapha nezengqondo Lokhu kungaba imbangela, umphumela, noma kokubili: ukukhathazeka, ukucindezeleka, ubuhlungu obungapheli, ukusebenzisa kabi izidakamizwa, izimo zokuphefumula noma zenhliziyo. Emphakathini wethu, abangaphezu kwengxenye yalabo abahlushwa ukuqwasha baye baphendukela ku- amaphilisi okulala, ikakhulukazi ama-benzodiazepinekuyilapho bembalwa kakhulu abathole ukwelashwa kwengqondo okuthile, naphezu kokuba yindlela yokwelapha ekhethwayo.
I-International Classification of Sleep Disorders (ICSD-3) ihlukanisa izinhlobo eziningana zokungalali, lapho amaqembu amathathu amakhulu avelele khona: ukuqwasha okungapheli (izimpawu okungenani kathathu ngesonto izinyanga ezintathu noma ngaphezulu, kanye nomphumela wasemini), ukuqwasha kwesikhashana (ubunzima obufanayo kodwa ngaphansi kwezinyanga ezintathu zokuziphendukela kwemvelo) kanye nesigaba esisele se- ezinye izinhlobo zokungalali, isetshenziswa lapho izindinganiso ezingenhla zingahlangatshezwanga ngokugcwele noma kungekho ulwazi olwanele lokuxilongwa okuqondile.
Ngale kwezincazelo zobuchwephesheKubalulekile ukukhumbula ukuthi ukuqwasha kuyimpawu engaguquguquka: iyafika futhi idlule, iba yimbi kakhulu ngezikhathi zokucindezeleka noma ukugula, futhi ithuthuke ngokushintsha kwemikhuba. Lokhu kuhlukahluka kusho ukuthi izifundo ezisekelwe ocwaningweni olulodwa ekuqaleni kwesikhathi sokulandelela zingase zinciphise noma zilinganisele ngokweqile inkinga yangempela.
Ukulala njengensika yesine yempilo yenhliziyo nemithambo yegazi
Izifo zenhliziyo nemithambo yegazi zihlala ziyi- imbangela ehamba phambili yokufa emhlabeniUmfutho wegazi ophakeme uvelele njengesici esibaluleke kakhulu sengozi: eYurophu, cishe umuntu oyedwa kwabathathu abadala une-hypertension, elingana nabantu abangaphezu kwezigidi ezingu-230. Ngokwesiko, kuye kwacatshangelwa izisekelo ezintathu eziyisisekelo zokuvimbela: ukudla okunempilo, umsebenzi womzimba ojwayelekile, kanye nenhlalakahle engokomzwelo.
Eminyakeni yamuva nje, leli phupho lithole ukuqashelwa kwalo njenge insika yesine yempiloIzifundo eziningi zikhombisile ukuthi kokubili isikhathi sokulala esinganele (ukulala kancane kakhulu noma, ngezinga elincane, kakhulu) kanye nekhwalithi ephansi (ukulala okuqhekekile, okungavuseleli, ukuba khona kwezinkinga ezithile) kuhlotshaniswa kakhulu nokuthuthukiswa kwe umfutho wegazi ophakeme, isifo senhliziyo esibangelwa yi-ischemic, ukwehluleka kwenhliziyo, isifo sohlangothi, kanye nokufa kwenhliziyo.
Ubufakazi besayensi obutholakalayo busekela ukuhlukaniswa kwezinkinga zokulala njengengxenye yeqembu izici ezinkulu ezingabangela ukuguquka kwengozi yenhliziyo...kufana nokubhema, ukukhuluphala ngokweqile, noma i-dyslipidemia. Ukulahlekelwa ubuthongo obungapheli sekuyinto eyenzeka empilweni yanamuhla: amahora amaningi okusebenza, ukuchayeka ebusuku ezikrinini, ukucindezeleka njalo Futhi ukuntuleka kolwazi lomphakathi ngemiphumela yesikhathi eside yokungalali kahle kuholela ekwandeni kwabantu abaswele ubuthongo.
Izifundo ezahlukahlukene ze-epidemiological zikhombisile ukuthi abantu abalala njalo ngaphansi kwamahora ayisithupha ebusuku banayo ingozi eyengeziwe yomfutho wegazi ophakeme, isifo senhliziyo, isifo sohlangothi, ukukhuluphala, isifo sikashukela sohlobo 2, kanye nesifo se-metabolic syndromeNgaphezu kwakho konke lokhu, kunemiphumela empilweni yengqondo kanye nokusebenza kwengqondo. Ngakho-ke, ukugcina iphethini yokulala eyanele (kubantu abadala, cishe amahora angu-7-8 okulala okuvamile, okuvuselelayo ebusuku) kuhlotshaniswa nokubikezela okungcono kwesifo senhliziyo kanye nobude besikhathi sokuphila obungenazo izenzakalo.
Ukungalali kanye nokwehluleka kwenhliziyo: lokho okushiwo yizifundo
Ukwehluleka kwenhliziyo kungenye yezinkinga izinselele ezinkulu zemitholampilo zansuku zonkeNaphezu kokuthuthuka ekwelashweni ngemithi kanye namadivayisi, kusalokhu kuyisifo esibi esinciphisa kakhulu inani kanye nekhwalithi yokuphila. Kulinganiselwa ukuthi cishe ama-70% ezinkinga zenhliziyo nemithambo yegazi zibangelwa yisifo senhliziyo nemithambo yegazi. izici zengozi eziguquguqukayoYingakho kunesifiso esikhulu sokuzibona kusenesikhathi nokuziphatha kahle.
Ucwaningo olukhulu kakhulu lweqembu, olusekelwe ku- Isifundo Sezempilo Nomhlalaphansi Ucwaningo oluvela e-United States luhlaziye abantu abangu-12.761 abaneminyaka engaphezu kwengu-50, abalandelwa iminyaka eyi-16. Ekuqaleni, abangu-38,4% babahlanganyeli babike okungenani ukuthi uphawu lokungalaliUbunzima bokulala, ukuvuka ebusuku, ukuvuka ekuseni kakhulu, noma umuzwa wokungalali kahle. Ngesikhathi sokulandelela, abantu abayi-1.730 baba nokwehluleka kwenhliziyo.
Imiphumela ibonise ukuthi ngasinye sezimpawu zokungalali ezicatshangelwe sasihlotshaniswa ne- ukwanda okukhulu kwengozi yokwehluleka kwenhliziyocishe ngokuphindwe ka-1,2 uma kuqhathaniswa nalabo abangenazo lezi zinkinga zokulala. Kodwa okuphawuleka kakhulu kwaba umphumela ohlangene: ingozi yanda kancane kancane njengoba inani lezimpawu likhona.
- Uphawu lokungalali Kwakuhlotshaniswa nengozi enkulu ngokuphindwe ka-1,22 yokuhlaselwa yisifo senhliziyo.
- Izimpawu ezimbili kuhlotshaniswa nengozi enkulu ngokuphindwe ka-1,45.
- Izimpawu ezintathu Bakhuphule ingozi yaba izikhathi ezingu-1,66.
- Izimpawu ezine (ukungalali kahle kwayo yonke inkazimulo yayo) kwandisa ingozi yaba izikhathi ezingu-1,80.
Le mininingwane iphakamisa ukuthi Izimpawu zokungalali kahle zihlotshaniswa nokwehluleka kwenhliziyo kokubili ngokwahlukile nangokuqoqana, ngakho-ke kufanele kubhekwe njengento entsha eyingozi okufanele icatshangelwe emtholampilo. Akuyona nje indaba yokubuza ngomfutho wegazi, ukubhema, noma i-cholesterol: uhlu lwemibuzo olufushane kufanele lufakwe ngendlela ehlelekile. ukuhlolwa kwemikhuba yokulala kanye nekhwalithi.
Kodwa-ke, ababhali nochwepheshe ababukeze lezi zifundo baveza ukuthi lesi simo asilula kangako. Ukungalali kuyinto eshintshayo, okunzima ukuyilinganisa ngokunembile, futhi ethonywa kakhulu yi- ukucindezeleka, izifo ezihambisanayo, kanye nezici zomphakathiNgaphezu kwalokho, ezifundweni eziningi zokubukela, akunakuphikwa ukuthi ukuqwasha okuthile kubangelwa ukuphazamiseka kokuphefumula okuhlobene nokulala okufana... ukuphazamiseka kokulala okuvalekileesikwaziyo ngokusobala ukuthi kuyisici esinamandla esiyingozi senhliziyo nemithambo yegazi.
Omunye umbuzo obalulekile Umbuzo uwukuthi ingabe ukuqwasha kuyimbangela eqondile yokwehluleka kwenhliziyo noma kunalokho kuyisibonakaliso se-pathophysiology eshintshile kabanzi (imikhuba emibi yokuphila, ukuvuvukala, ukungalingani kwamahomoni) okuholela ekulimaleni kwenhliziyo. Kudingeka ucwaningo olwengeziwe, kodwa ngokwezinto ezingokoqobo, ukuhlanganisa ukuhlolwa kokulala ekuhlolweni kwengozi yenhliziyo nemithambo yegazi kakade kuyisinyathelo esinengqondo.
Indlela ukuqwasha okulimaza ngayo inhliziyo: izindlela zebhayoloji
Ubudlelwano phakathi kokungalali kahle nesifo senhliziyo abuchazwa ngendlela eyodwa, kodwa buchazwa inani lezindlela ze-pathophysiological ezixhumenePhakathi kwezinto ezifanele kakhulu yilezi:
Okokuqala, ukungakwazi ukulala kuvame ukuhlotshaniswa imikhuba yokuphila engenampiloUkudla okungekuhle, indlela yokuphila yokungahlali phansi, ukusebenzisa utshwala nogwayi, kanye nezinhlelo ezingajwayelekile konke kunomthelela ekulaleni okungekuhle. Lokhu kwenza ukusebenza kahle emini kanye nogqozi lube lubi, okwenza kube nzima ukugcina imikhuba enempilo. Lokhu kudala umjikelezo omubi lapho imikhuba emibi ibenza bube bubi khona, kanti ukulala kabi kwenza kube nzima ukushintsha imikhuba.
Okwesibili, ezingeni lebhayoloji, ukuqwasha okungapheli kubhekwa njengesimo sokungalali kahle. ukusebenza ngokweqile okunesimoEsikhundleni sokuba ithoni ye-parasympathetic ibuse kanye nokuphumula okwenzeka ebusuku, umzimba ugcina izinga eliphezulu lokusebenza kwe- isimiso sezinzwa esinozwela kanye ne-hypothalamic-pituitary-adrenal (HPA). Lokhu kuphumela ekwandeni kwesilinganiso senhliziyo, umfutho wegazi, kanye nokukhiqizwa kwama-hormone okucindezeleka njenge-cortisol.
Izifundo eziningana zikhombisile ukuthi abantu abanenkinga yokungalali, ikakhulukazi labo abanenkinga yokungalali kahle isikhathi sokulala esifushane esingaqondileZibonisa amazinga aphezulu e-hormone ye-adrenocorticotropic (ACTH) kanye ne-cortisol, kokubili emini nasebusuku. Lokhu kusebenza okungapheli kwe-axis ye-HPA akugcini nje ngokwandisa ingozi yenhliziyo kodwa futhi kukhuthaza... ukumelana ne-insulin, isifo sikashukela sohlobo 2, kanye nezinkinga zengqondo njengokukhathazeka nokucindezeleka.
Enye indlela ebalulekile ukuvuvukala kwesistimu okuphansiUkungalali kahle nezinye izinkinga zokulala kuye kwahlotshaniswa namazinga aphezulu ama-cytokine abangela ukuvuvukala ahilelekile ekukhuleni kwe-atherogenesis kanye nokungasebenzi kahle kwe-endothelial, okusheshisa ukwakheka kwama-plaque e-atherosclerotic futhi kunegalelo ekuqineni kwemithambo yegazi. Izinguquko ekuguqulweni kwesistimu yezinzwa ezizimele nazo ziye zachazwa, ngomsebenzi okhulayo wokuzwela kanye nokwehla kwethoni yesitho sangasese sowesifazane, okusiza ukuthuthukiswa... arrhythmias.
Okungeziwe kulokhu kukhona izinguquko ze-metabolic: ukungakwazi ukulala kahle kungabangela izinguquko ekukhiqizweni kwe- i-leptin ne-ghrelinAma-hormone alawula isifiso sokudla, akhuthaza indlala eyandayo kanye nokukhetha ukudla okunama-calorie amaningi. Ngokuhamba kwesikhathi, lokhu kuholela engcupheni enkulu yokuthi ukukhuluphala, i-dyslipidemia kanye ne-metabolic syndrome, konke kuhlobene kakhulu nokuthuthukiswa kwe-CVD.
Ukungalali, umfutho wegazi ophakeme, nezinye izifo zenhliziyo
Phakathi kweziguli ezinesifo senhliziyo esivele sikhona, ukwanda kwesifo Ukungalali kuphakeme kakhuluUbudlelwano buhambisana nezinhlangothi ezimbili: Izifo ze-CVD zingadala ubuthongo obunzima (ngenxa yezimpawu, imithi, ukukhathazeka) kanti ukungakwazi ukulala, nakho, kungakhuthaza ukuqhubeka kwesifo.
Izifundo eziningana zokubuka kanye nokuhlaziywa kwe-meta kuthole ukuthi ukungakwazi ukulala kuhlotshaniswa ne- ingozi eyengeziwe yokucindezeleka kwegazi, ukwehluleka kwenhliziyo, kanye nesifo senhliziyoikakhulukazi uma kuhlanganiswa nesikhathi sokulala esifushane (ngaphansi kwamahora ayi-6). Ngokuphathelene nokufa ngenxa yesifo senhliziyo nemithambo yegazi, ubufakazi buyahlukahluka kakhulu, kodwa idatha eningi ikhomba ku- ingozi enkulu yokufa ngenxa ye-CVD kulabo abalala kabi njalo.
Iphuzu elithakazelisayo yindima ye- ukuthambekela kwezakhi zofuzo kokungalaliIzifundo ze-Mendelian ezingahleliwe zibonise ukuthi ukuthambekela kwezakhi zofuzo kokungalali kuhlotshaniswa nengozi eyengeziwe yesifo semithambo yegazi engaphandle, ukwehluleka kwenhliziyo, isifo semithambo yegazi yenhliziyo, isifo sohlangothi esibangelwa yi-ischemic, i-venous thromboembolism, kanye ne-atrial fibrillation. Lokhu kusikisela ukuthi, ngale kwezici zokuziphatha, kunezingxenye eziphilayo ezihlanganyelwe ezingaba yizinhloso zokuvimbela.
Ngaphezu kwalokho, kuye kwaphawulwa ukuthi abantu abaphuza imithi yokulala njalo babonisa ukusetshenziswa okwengeziwe kwemithi yokulwa nomfutho wegazi ophakemeOkusho ukuthi, isidingo sokuphendukela ku- amaphilisi okulala Lokhu kungaba uphawu oluyisixwayiso sokwelashwa kwengcindezi yegazi esikhathini esizayo. Njengamanje, kunezivivinyo ezimbalwa zemitholampilo eziklanywe kahle ezihlola ukuthi ukwelapha ukungakwazi ukulala kunciphisa umfutho wegazi noma izehlakalo zenhliziyo, futhi imiphumela ixubile, kodwa umbono uya ngokuya ubonakala.
Ubudlelwano obuseduze phakathi izinkinga zokulala, ukucindezeleka, kanye ne-CVDUkungalali kuyisici esiyingozi sokucindezeleka, kanti ukucindezeleka, nakho, kuhlotshaniswa nethuba eliphezulu lokuthuthukisa izehlakalo zenhliziyo kanye nokubikezela okubi kakhulu ngemva kokuhlaselwa yinhliziyo noma isifo sohlangothi. Ngakolunye uhlangothi, ukuvivinya umzimba njalo kubonakala kuyindlela enamandla yokulawula: kunciphisa ingozi yokucindezeleka, ukukhuluphala ngokweqile, kanye nesifo senhliziyo, kanti ezinye izifundo ziphakamisa ukuthi kunganciphisa noma kuqede ngisho nokufa ngokweqile okuhlobene nokungalali kahle.
Ezinye izinkinga zokulala kanye nengozi yenhliziyo
Nakuba ukuqwasha kuthola ukunakwa okukhulu, akuyona yodwa inkinga yokulala ethinta inhliziyo. Ukuphefumula kobuthongo okuvimbelayo (OSA)I-restless legs syndrome noma i-obesity hypoventilation syndrome ziyizibonelo ezicacile zezimo ezithinta ukulala futhi zandise ingozi yenhliziyo nemithambo yegazi.
I-OSA yisifo esivame kakhulu esithinta abantu abadala abangaphezu kuka-20%Kubonakala ngeziqephu eziphindaphindwayo zokuvinjelwa okuyingxenye noma okuphelele kwendlela yokuphefumula ephezulu ngesikhathi sokulala, okubangela ukumiswa kwesikhashana kokugeleza kokuphefumula, ukwehla kokugcwala komoya-mpilo, ukunyakaza okukhulu kwengcindezi yangaphakathi kwesifuba kanye nokuvuka okuncane okubangela ukulala okuqhekekile.
Lezi ziqephu ze ukuvuselelwa kabusha kwe-oxygen ngezikhathi ezithile Zivuselela njalo uhlelo lwezinzwa oluzwelanayo, zikhiqize ukucindezeleka kwe-oxidative, ukuvuvukala, kanye nokungasebenzi kahle kwe-endothelial, futhi zibangele isimo sokujiya kwegazi kanye nokungasebenzi kahle kwe-metabolic. Umphumela uba yingozi enkulu kakhulu yokuthi umfutho wegazi ophakeme, isifo semithambo yenhliziyo, isifo sohlangothi, ukwehluleka kwenhliziyo, kanye nokuphazamiseka kwenhliziyo njenge-atrial fibrillation.
Eqinisweni, abantu abangaphezu kwengxenye abanomfutho wegazi ophakeme banezinga elithile lokuphefumula kokulala, futhi bafinyelela ku- Ama-70% alabo abaye bahlushwa yi-acute coronary syndrome Bane-OSA. Empeleni, kuvamile kakhulu ukuthola iziguli ezine-hypertension engazweli (okunzima ukuyilawula ngemithi) okutholakala kuzo ukuthi zine-sleep apnea engakatholakali ngaphambilini.
El i-RLS (i-RLS) yemilenze ephumuzayo I-RLS ingenye inkinga yokulala ehlobene nesifo senhliziyo, nakuba ingakafundwa kangako. Ichazwa yisifiso esingenakuphikiswa sokunyakaza imilenze, esibi kakhulu ntambama nakusihlwa, esithuthuka ngokunyakaza futhi siba sibi kakhulu lapho uphumule. Iziguli eziningi ezine-RLS zithola ukunyakaza kwezitho ngezikhathi ezithile ngesikhathi sokulala okuhlotshaniswa nokunyuka okungazelelwe kwesilinganiso senhliziyo kanye nomfutho wegazi, ukulala okuqhekeka futhi kukhuthaze izindlela ze-neural, metabolic, ukuvuvukala, kanye nemithambo yegazi efana naleyo echazwe ku-obstructive sleep apnea (OSA).
Ekugcineni, i i-obesity hypoventilation syndrome (OHSS)Lesi simo, esibonakala ngokuphefumula okuqhubekayo kwe-alveolar kubantu abakhuluphele, sihlotshaniswa nokuntuleka komoya okungapheli, i-hypercapnia, kanye nengozi ephezulu kakhulu yomfutho wegazi ophakeme wamaphaphu kanye nokwehluleka kwenhliziyo kwesokudla. Uma kuhambisana ne-obstructive sleep apnea (OSA), ukubikezela kwesifo senhliziyo nemithambo yegazi kuba kubi nakakhulu.
Amaphethini okulala anempilo kanye nengozi encishisiwe yenhliziyo
Ngaphandle kokutadisha isifo ngasinye ngokwehlukana, ezinye izifundo zihlaziye ukuhlanganiswa kwezingxenye eziningana zokulala zibe yi- isilinganiso "sokulala okunempilo" sisonkeIsibonelo esisodwa ucwaningo oluhlanganise idatha evela kumaqembu amabili amakhulu aseYurophu, enabahlanganyeli abangaphezu kuka-11.000 abangenazo izifo zenhliziyo ekuqaleni, olulandelwe iminyaka eminingana.
Kulo msebenzi, kwakhiwa inkomba eyayihlanganisa izinto eziguquguqukayo ezifana I-chronotype yasekuseni, isikhathi sokulala samahora angu-7-8 nsuku zonke, ukungabikho kokulala, ukungabikho kwe-sleep apnea kanye nokungabikho kokulala ngokweqile eminiIsici ngasinye esinempilo sengeze iphuzu elilodwa, ngakho-ke amaphuzu aphelele angasukela ku-0 kuya ku-5.
Imiphumela yayicacile kakhulu: kuwo wonke amaphuzu engeziwe kumaphuzu okulala anempilo, ukwehla okuqhubekayo kwengozi yesifo senhliziyoUma kuqhathaniswa nalabo abanamaphuzu aphansi kakhulu:
- Amaphuzu angu-2 ahlotshaniswa nengozi ephansi ngo-10%.
- Isilinganiso esingu-3, kanye no-19% ongaphansi.
- Isilinganiso esingu-4, kanye no-38% ongaphansi.
- Futhi amaphuzu angu-5, kanye nengozi ye-CVD engaphansi ngo-63%.
Kwalinganiselwa ukuthi phakathi 30% kanye no-60% wezehlakalo zenhliziyo Le miphumela ingavinjelwa uma abantu bethola iphethini yokulala efanele okungenani kulezo zakhi ezine noma ezinhlanu. Ngaphezu kwalokho, kwakungeyona nje indlela abantu abalala ngayo ekuqaleni eyayibalulekile: labo abathuthukise amaphuzu abo okulala anempilo ngesikhathi sokulandelela nabo babone kunciphisa kakhulu ingozi yabookubonisa ukuthi akukaze kube sekwephuzile ukuqala ukunakekela ubuthongo bakho.
Lokhu okutholakele kunikeza ukuqonda okunamandla: ukungenelela kwezokwelapha kanye nezempilo yomphakathi okuhloswe ngakho thuthukisa ikhwalithi yokulala iyonke (hhayi nje ukwelapha isifo esithile) kungaba isu eliphumelelayo lokunciphisa umthwalo wesifo senhliziyo kubantu abaningi.
Ukwelashwa kokungalali: ngale kwamaphilisi okulala
Emsebenzini wansuku zonke, odokotela abaningi bezokwelapha abayinhloko bavame ukuphendukela ngokushesha imithi yokwelapha i-hypnotic, ikakhulukazi ama-benzodiazepines kanye, ngezinga elincane, neminye imithi yokucindezeleka edambisa ukucindezeleka. Kodwa-ke, iziqondiso zaseYurophu naseMelika zigcizelela ukuthi umgomo kufanele ube ukunciphisa ukusetshenziswa kanye nokusetshenziswa kabi kwale mithiukuzigcina isikhathi esifushane kanye nezimo ezithile kakhulu.
Izincomo zamanje zicacile: I-Cognitive Behavioral therapy for Insomnia (CBT-I) Kuyindlela yokuqala yokwelapha ukuqwasha okungapheli kubantu abadala banoma yimuphi ubudala. Iqukethe isethi yamasu ahlelekile engqondo (imfundo yokulala, ukuhlela kabusha imicabango engasebenzi kahle, ukulawula ukuvuselela, ukuvinjelwa kokulala, amasu okuphumula, njll.) okuhloselwe ukuphula umjikelezo omubi wokuvuka ebusuku kanye nokwesaba ukungalali.
Uma i-CBT-I ingatholakali, inganele yodwa, noma isiguli singakwazi ukuyifinyelela, okulandelayo kungacatshangelwa: ukusetshenziswa kwezidakamizwa zesikhashana (ngokuvamile kungabi ngaphezu kwamasonto ama-4). Ama-Benzodiazepine kanye neminye imithi yokucindezeleka ibonise ukusebenza kahle ekwelapheni ukungakwazi ukulala isikhathi esifushane, kodwa ukusetshenziswa kwayo isikhathi eside akukhuthazwa ngenxa yengozi yokubekezelela, ukuthembela, ukuwa, ukukhubazeka kwengqondo, kanye neminye imiphumela emibi, ikakhulukazi kubantu abadala asebekhulile.
Ezinye izindlela ezivamile zemithi, njenge ama-antihistamine, ama-antipsychotics, i-melatonin, imikhiqizo emangalisayo yokungalali Imithi yamakhambi kanye nezinye izindlela zokwelapha zinobufakazi obubuthakathaka noma obulinganiselwe kakhulu, futhi ngokuvamile, iziqondiso azizincomi njengezindlela zokwelapha ezijwayelekile zokungalali kahle okungapheli. Ngokufanayo, ezinye izindlela zokwelapha ezifana ne-homeopathy noma i-acupuncture azinalo ukwesekwa okuqinile kwesayensi.
Umhlahlandlela we-American Academy of Sleep Medicine uphinde usekele i-CBT-I futhi uphakamisa amasu athile okuziphatha afana nalawa i-stimulus control (ukuhlanganisa umbhede nokulala nokuphumula kuphela, ukugwema imisebenzi ethokozisayo), ukunqunyelwa kwesikhathi embhedeni (ukwandisa ingcindezi yokulala nokuthuthukisa ukuqina kwayo) kanye namasu ahlukahlukene okusebenza ukuphathwa kokuphumula nokusebenzaUkuhlanzeka kokulala kuphela akwanele ukwelapha ukungakwazi ukulala okungapheli okukhona, kodwa kuyindawo ewusizo yokuqala.
Phakathi kwezinyathelo eziyisisekelo zokuhlanzeka kokulala ezinganconywa yinoma yimuphi udokotela yilezi: ukugcina amahora avamile yokulala nokuvuka (kufaka phakathi izimpelasonto), ukulala kuphela uma ulele, ukuvuka uma ungakwazi ukulala ngesikhathi esifanele ukuze wenze okuthile buthule, ukuqinisekisa ukuthi Indawo efanelekayo (izinga lokushisa elihle, ubumnyama, ukuthula, umatrasi okhululekile), dla isidlo sakusihlwa esilula nesisesikhathini, gwema izikhuthazi notshwala emahoreni angaphambi kosuku, ukunciphisa isikhathi sokulala (kungadluli imizuzu engama-20-30, ungalokothi ulale ntambama), yenza umsebenzi womzimba ojwayelekile kodwa hhayi ngaphambi nje kokulala, futhi unciphise ukusetshenziswa kwe- izikrini embhedeni futhi uqalise imikhuba yokuphumula ngaphambi kokulala.
Ukwelashwa kwe-sleep apnea nezinye izifo ezihlobene nayo
Uma kwenzeka i-obstructive sleep apnea, ukwelashwa okujwayelekile yilokhu umfutho womoya oqhubekayo omuhle (CPAP)Kuyithuluzi eligcina indlela yokuphefumula ivulekile ngesikhathi sokulala ngokuletha ukugeleza komoya okuqhubekayo ngemaski yekhala noma ye-oronasal. Izilingo eziningi zibonise ukuthi i-CPAP Kunciphisa ubuthongo basemini, kuthuthukisa ikhwalithi yokulala, futhi kuthuthukisa ikhwalithi yokuphila. kweziguli ezine-OSA.
Ngokombono wezifo zenhliziyo, i-CPAP ibonise umphumela ophansi kodwa obalulekile emtholampilo ukulawula umfutho wegazingokwehla okumaphakathi cishe okungu-2 mmHg, ikakhulukazi ezigulini ezine-hypertension engamelani noma i-hypertension yasebusuku kakhulu. Ukuze uthole lezi zinzuzo, okungenani [iphesenti elithile] lemithi liyadingeka. Amahora ama-4 ngobusuku njalo.
Idatha yokuthi i-CPAP iyanciphisa yini ngokucacile izehlakalo ezinkulu zenhliziyo (ukuhlaselwa yinhliziyo, isifo sohlangothi, ukufa kwenhliziyo) iyinkimbinkimbi kakhulu. Ekuvimbeleni okuyinhloko, ubufakazi bukhomba umphumela wokuvikela, kanti ekuvimbeleni kwesibili (iziguli esezike zabhekana nesigameko) imiphumela ayizange ibe yiqiniso. Kungenzeka ukuthi kukhona amaphrofayili athile eziguli asengozini enkulu yemiphumela eyingozi ye-OSA, lapho ukwelashwa kuba nomthelela omkhulu, ngakho-ke kugxilwe kakhulu emithini yokulala eyenzelwe wena.
Ngaphezu kwe-CPAP, kukhona amadivayisi okuthuthukisa i-mandibular (MADs) Lawa madivayisi abeka umhlathi phambili ukuze agcine umgudu womoya uvulekile, futhi awusizo ikakhulukazi ezimweni ezincane kuya kweziphakathi ze-OSA. Nakuba ngokuvamile engasebenzi kahle njenge-CPAP ezifweni ezinzima zokuphefumula, ezinye izifundo zibonisa ukuthi, maqondana nokunciphisa umfutho wegazi, anganikeza izinzuzo ezifanayo ezigulini ezithile. Ukwelashwa okusha yi- ukukhuthazwa kwemizwa ye-hypoglossalokwandisa ithoni yemisipha yolimi ngesikhathi sokulala ukuvimbela ukuwa komphimbo; imiphumela yokuqala iyathembisa, kodwa kusadingeka izifundo ezengeziwe zesikhathi eside.
Ku-obesity hypoventilation syndrome, ukwelashwa kuhlanganisa ukwehlisa isisindo, ukwesekwa kokuphefumula (i-CPAP noma i-BiPAP, njengoba kufanele) kanye nokuphathwa okujulile kwezinto ezihambisana nezingozi. Nge-RLS, indlela ihlanganisa ukulungiswa kwezinto ezingenzeka ukungabi nensimbiizinyathelo zokuhlanzeka kokulala, futhi ngezinye izikhathi, imithi ethile, njalo ihlola umthelela esakhiweni sokulala kanye nengozi engaba khona yenhliziyo nemithambo yegazi.
Ukungalali, ukugula okubangelwa yizifo ezihambisana nakho, kanye nomthelela empilweni yangempela
Ukuntuleka kokulala okuhle akugcini nje ngokulimaza inhliziyo: kuphinde kuthinte kakhulu ukuqonda, isimo sengqondo, kanye nokusebenzaEbusuku, ikakhulukazi ngesikhathi sokulala kwamagagasi aphansi kanye nokulala kwe-REM, ubuchopho kuqinisa inkumbulo futhi kuqinisa ukuxhumana kwezinzwa. Uma lezi zigaba ziphazanyiswa ngokuphindaphindiwe ukuvuka, ukuqwasha, noma ukuphelelwa umoya, kuvela izinkinga ukukhohlwa njalo, ubunzima bokugxilisa ingqondo, ikhono lokufunda elinciphile kanye nokuthambekela okukhulu kwezifo eziwohlokayo zemizwa.
Ngokwemizwa, ngemva kobusuku obubodwa nje bokulala kabi, ukwanda... ukucasuka, ukudabuka, kanye nobunzima obungokomzwelokanye nokwehla kwamandla kanye nogqozi. Uma inkinga iba yinde, ingozi yokuba ukukhathazeka nokudangalaUcwaningo luye lwabonisa ukuthi ukulala amahora angaphansi kuka-4,5 ebusuku isonto lonke kunciphisa ngokusobala inhlalakahle yemizwa futhi kushintsha indlela ubuchopho obusingatha ngayo imizwa.
Okuhlangenwe nakho kwezokwelapha ngamayunithi okulala akhethekile kuyamangalisa kakhulu. Iziguli eziningi ziza zikhononda ngakho ukukhohlwa, ukuntuleka kokugxilisa ingqondo, noma "inkungu yobuchopho" Futhi abaqapheli njalo indima ebalulekile edlalwa yikhwalithi yokungalali kahle kulezi zimpawu. Ngokwelapha ukungakwazi ukulala, ukuthuthukisa ukuphumula, kanye, uma kufaneleka, nokwelapha i-sleep apnea, akuvamile ukubona ukuthuthuka ekulawuleni umfutho wegazi, ukusebenza kwengqondo, kanye nemizwelo.
Ubhubhane lwe-COVID-19 luphinde lwagqamisa le nkinga: izifundo eziningana zibonise ukuthi ukwanda kwezimpawu zokungalali phakathi kochwepheshe bezempilo ababesebenza emigqeni engaphambili belwa naleli gciwane, uma kuqhathaniswa nabanye abasebenzi. Umsebenzi wamashifu, ngokwawo, uhlotshaniswa nengozi eyengeziwe ye-CVD, mhlawumbe ngenxa ukungalungi kahle kwe-circadian okungapheliukungalali kahle kanye nokushintsha kokudla kanye nomsebenzi womzimba.
Ngemuva kwakho konke lokhu kukhona nengxenye yezenhlalo neyezepolitiki: naphezu kobufakazi obutholakalayo obuxhumanisa ngokusobala izinkinga zokulala nempilo yenhliziyo neminye imiphumela, kusekhona Akukho uhlelo oluphelele lokuvikela impilo yokulala kwabantu. Kudingeka isinyathelo esiphuthumayo sokukhuthaza ukulala njengomkhuba onempilo, okuqinisekisa ilungelo lokulala ezimweni ezifanele (umsindo kuma(amahora okusebenza, ibhalansi yomsebenzi nempilo) futhi kukhuthazwe ucwaningo oluvumela indlela enembile neqondene nawe yokuxazulula izinkinga zokulala.
Konke kukhomba kulokho Ukunakekela ubuthongo bakho kungaphezu nje kokuthi "ukungabi nemibuthano emnyama ngaphansi kwamehlo akho"Lokhu kuhilela ukuvikela inhliziyo, ubuchopho, i-metabolism, kanye nempilo yengqondo. Ukuhlanganisa ukuhlolwa kokulala emisebenzini ejwayelekile yezokwelapha, ukubeka phambili izindlela zokwelapha zokuziphatha kunokusebenzisa imithi yokwelapha ngokweqile, ukuxilonga nokwelapha i-sleep apnea, kanye nokufundisa umphakathi ngemikhuba yokulala enempilo kuyizinyathelo ezibalulekile zokunciphisa ingxenye enkulu yengozi yenhliziyo esiyamukela njengamanje njengengenakugwenywa.
