nūhou

ʻO ka insomnia ka maʻi moe maʻamau, i wehewehe ʻia he maʻi hiamoe e hiki mai ana ʻekolu a ʻoi aku paha mau pō i kēlā me kēia pule, ʻoi aku ma mua o ʻekolu mahina, a ʻaʻole i kumu ʻia e ka nele o nā manawa hiamoe. Ma kahi o 10% o nā mākua e hoʻokō i nā koina no ka insomnia, a ʻo kekahi 15% a 20% e hōʻike i nā hōʻailona insomnia i kekahi manawa. ʻO ka poʻe maʻi insomnia lōʻihi ka nui o ka pilikia o ka ulu ʻana i ke kaumaha nui, ke kiʻekiʻe kiʻekiʻe, ka maʻi Alzheimer, a me ka nalowale o ka hana.

Nā pilikia pili kino

ʻO nā hiʻohiʻona o ka insomnia ʻaʻole maikaʻi ka maikaʻi o ka hiamoe a i ʻole ka lōʻihi, i hele pū ʻia me ka paʻakikī i ka hiamoe ʻana a i ʻole ka mālama ʻana i ka hiamoe, a me ka pilikia noʻonoʻo nui a i ʻole nā ​​​​hana o ke ao. ʻO ka insomnia kahi maʻi hiamoe e hiki mai ana ʻekolu a ʻoi aʻe paha pō o ka pule, ʻoi aku ma mua o ʻekolu mahina, a ʻaʻole i hoʻokumu ʻia e nā manawa hiamoe. Loaʻa pinepine ʻia ka insomnia me nā maʻi kino ʻē aʻe (e like me ka ʻeha), nā maʻi noʻonoʻo (e like me ke kaumaha), a me nā maʻi hiamoe ʻē aʻe (e like me ka restless leg syndrome a me ka hiamoe apnea).

ʻO ka insomnia ka maʻi moe maʻamau i waena o ka lehulehu, a ʻo ia kekahi o nā pilikia i ʻōlelo pinepine ʻia i ka wā e ʻimi ai nā maʻi i ka lāʻau lapaʻau ma nā keʻena lapaʻau mua, akā hele pinepine ʻole ʻia. Ma kahi o 10% o ka poʻe mākua e hoʻokō i nā koina no ka insomnia, a ʻo kekahi 15% a 20% o nā pākeke e hōʻike i nā hōʻailona insomnia i kekahi manawa. ʻOi aku ka maʻamau o ka insomnia i nā wahine a me nā poʻe me nā pilikia noʻonoʻo a i ʻole ke kino, a e piʻi aʻe ka nui o ka hopena ma waena o ka makahiki waena a ma hope o ka makahiki waena, a me ka perimenopause a me ka menopause. ʻIke liʻiliʻi loa mākou e pili ana i nā ʻano pathological a me ka physiological o ka insomnia, akā i kēia manawa ua manaʻo ʻia ʻo ka psychological a me ka physiological overstimulation kona mau hiʻohiʻona.

Hiki i ka insomnia ke kūlana a i ʻole kekahi manawa, akā ma luna o 50% o nā maʻi e ʻike i ka insomnia mau. ʻO ka insomnia mua ka mea maʻamau mai kahi nohona koʻikoʻi, nā pilikia olakino, nā papa hana maʻamau, a i ʻole ka hele ʻana ma nā wahi he nui (ʻokoʻa ka manawa). ʻOiai ʻo ka hapa nui o ka poʻe e hoʻi i ka hiamoe maʻamau ma hope o ka hoʻololi ʻana i nā hanana hoʻonāukiuki, hiki i ka poʻe maʻi i ka insomnia ke loaʻa i ka insomnia mau. ʻO nā kumu noʻonoʻo, ʻano, a i ʻole ke kino e alakaʻi pinepine ai i nā pilikia hiamoe lōʻihi. Hoʻopili ʻia ka insomnia lōʻihi me ka piʻi nui ʻana o ke kaumaha nui, ke kiʻekiʻe kiʻekiʻe, ka maʻi o Alzheimer, a me ka nalowale o ka hiki ke hana.

ʻO ka loiloi a me ka hōʻoia ʻana o ka insomnia e hilinaʻi ʻia i ka nīnau kikoʻī o ka mōʻaukala olakino, ka hoʻopaʻa ʻana i nā hōʻailona, ​​​​ke ala o ka maʻi, nā comorbidities, a me nā kumu hoʻoulu ʻē aʻe. ʻO ka hoʻopaʻa ʻana i ka hana hiamoe hiamoe 24-hola hiki ke ʻike i nā pahuhopu ʻoi aku ka hana a me ke kaiapuni. Hiki i nā mea hana loiloi i hōʻike ʻia e ka poʻe maʻi a me nā diary moe ke hāʻawi i ka ʻike waiwai e pili ana i ke ʻano a me ka paʻakikī o nā hōʻailona insomnia, kōkua i ka pale no nā maʻi hiamoe ʻē aʻe, a nānā i ka holomua o ka mālama ʻana.

Hoʻolālā a me nā hōʻike

ʻO nā ʻano hana o kēia manawa no ka mālama ʻana i ka insomnia, ʻo ia ka lāʻau lapaʻau a me nā lāʻau lapaʻau ma luna o ka counter, psychological and behavioral therapy (ʻike pū ʻia ʻo cognitive-behavioral therapy [CBT-I] no ka insomnia), a me nā adjuvant a me nā lāʻau lapaʻau ʻē aʻe. ʻO ke ala lapaʻau maʻamau no nā poʻe maʻi, ʻo ia ka hoʻohana mua ʻana i nā lāʻau lapaʻau ma mua o ka lāʻau lapaʻau a laila hoʻohana i nā lāʻau lapaʻau ma hope o ka ʻimi ʻana i ka lāʻau lapaʻau. He liʻiliʻi nā poʻe maʻi e loaʻa i ka lāʻau lapaʻau CBT-I, ma muli o ka nele o nā mea lapaʻau i hoʻomaʻamaʻa maikaʻi ʻia.

CBTI-I
Hoʻokomo ʻia ka CBT-I i nā ʻano hoʻolālā e pili ana i ka hoʻololi ʻana i nā ʻano hana a me nā kumu noʻonoʻo e alakaʻi ai i ka insomnia, e like me ka hopohopo nui a me nā manaʻo maikaʻi ʻole e pili ana i ka hiamoe. ʻO ka maʻiʻo nui o CBT-I e pili ana i nā hoʻolālā hana a me ka hoʻonohonoho ʻana i ka hiamoe (ka palena o ka hiamoe a me ka hoʻoulu ʻana), nā ʻano hoʻomaha, nā hana noʻonoʻo a me ka cognitive (a i ʻole nā ​​​​mea ʻelua) i manaʻo ʻia e hoʻololi i nā manaʻo maikaʻi ʻole a me nā hopohopo nui e pili ana i ka insomnia, a me ka hoʻonaʻauao hoʻomaʻemaʻe hiamoe. Ua hoʻohana pū ʻia nā ʻano hana noʻonoʻo ʻē aʻe e like me Acceptance and Commitment Therapy a me Mindfulness Based Therapy no ka mālama ʻana i ka insomnia, akā aia nā ʻikepili e kākoʻo ana i ko lākou pono, a pono lākou e hoʻomau ʻia no ka manawa lōʻihi e pōmaikaʻi ai. ʻO CBT-I kahi lāʻau lapaʻau e pili ana i ka hiamoe a pili i ka pilikia. Ke alakaʻi pinepine ʻia nei e ke kauka olakino noʻonoʻo (e like me ka psychologist) no 4-8 mau kūkākūkā. Aia nā ʻano hana hoʻokō like ʻole no CBT-I, me ke ʻano pōkole a me ka hui pūʻulu, me ke komo ʻana o nā ʻoihana mālama olakino ʻē aʻe (e like me ka hoʻomaʻamaʻa kahu), a me ka hoʻohana ʻana i nā telemedicine a i ʻole nā ​​​​pae kikohoʻe.

I kēia manawa, ʻōlelo ʻia ʻo CBT-I ma ke ʻano he lāʻau lapaʻau mua i nā alakaʻi lapaʻau e nā hui ʻoihana lehulehu. Ua hōʻike ʻia nā hoʻokolohua lapaʻau a me nā meta-analyses hiki iā CBT-I ke hoʻomaikaʻi nui i nā hopena i hōʻike ʻia e ka mea maʻi. I loko o ka meta-analysis o kēia mau ho'āʻo, ua ʻike ʻia ʻo CBT-I e hoʻomaikaʻi i ke koʻikoʻi o nā hōʻailona insomnia, ka manawa hoʻomaka o ka hiamoe, a me ka manawa ala ala hiamoe. ʻO ka hoʻomaikaʻi ʻana i nā hōʻailona o ke ao (e like me ka luhi a me ke ʻano) a me ka maikaʻi o ke ola he mea liʻiliʻi, ʻo kekahi ma muli o ka hoʻohana ʻana i nā hana maʻamau i kūkulu ʻole ʻia no ka insomnia. ʻO ka holoʻokoʻa, ma kahi o 60% a 70% o nā maʻi i loaʻa i kahi pane lapaʻau, me ka emi ʻana o 7 mau helu ma ka Insomnia Severity Index (ISI), mai ka 0 a 28 mau helu, me nā helu kiʻekiʻe e hōʻike ana i ka insomnia koʻikoʻi. Ma hope o 6-8 pule o ka mālama ʻana, ma kahi o 50% o ka poʻe maʻi insomnia e ʻike i ke kala ʻana (ka helu helu ISI, <8), a me 40% -45% o nā maʻi e loaʻa i ke kala mau no 12 mahina.

I loko o nā makahiki he ʻumi i hala iho nei, ua kaulana nui ʻia ka CBT-I (eCBT-I) kikohoʻe a hiki i ka hopena ke hōʻemi i ka ʻāpana koʻikoʻi ma waena o ke koi CBT-I a me ka hiki. He hopena maikaʻi ko ECBT-I i kekahi mau hopena hiamoe, e like me ke koʻikoʻi o ka insomnia, ka maikaʻi o ka hiamoe, ka maikaʻi o ka hiamoe moe, ka ala ʻana ma hope o ka hiamoe, ka lōʻihi o ka hiamoe, ka lōʻihi o ka hiamoe, a me ka helu o nā ala ala pō. Ua like kēia mau hopena me nā mea iʻikeʻia ma nā ho'āʻo CBT-I maka-a-maka a mālamaʻia no nā wiki 4-48 ma hope o ka hahaiʻana.

ʻO ka mālama ʻana i nā comorbidities e like me ke kaumaha a me ka ʻeha mau hiki ke hoʻēmi i nā hōʻailona insomnia, akā ʻaʻole hiki ke hoʻopau piha i nā pilikia insomnia. ʻO ka mea ʻē aʻe, hiki i ka mālama ʻana i ka insomnia ke hoʻomaikaʻi i ka hiamoe o nā maʻi me nā maʻi maʻi, akā ʻaʻole kūlike ka hopena i nā comorbidities iā lākou iho. ʻO kahi laʻana, hiki i ka mālama ʻana i ka insomnia ke hoʻohaʻahaʻa i nā hōʻailona depressive, hoʻemi i ka nui o ka hopena a me ka hoʻi hou ʻana o ke kaumaha, akā he liʻiliʻi ka hopena i ka ʻeha mau.

Hiki i ke ala lapaʻau pae ke kōkua i ka hoʻoponopono ʻana i ka pilikia o ka lawa ʻole o nā kumuwaiwai i koi ʻia no nā lāʻau kuʻuna noʻonoʻo a me ke ʻano. Manaʻo kekahi ʻano e hoʻohana i ka hoʻonaʻauao, ka nānā ʻana, a me nā ʻano kōkua ponoʻī ma ka pae mua, digital a hui pūʻulu psychological and behavioral therapy ma ka pae ʻelua, kanaka psychological and behavioral therapy ma ke kolu o ka pae, a me ka lāʻau lapaʻau ma ke ʻano he hoʻohui pōkole i kēlā me kēia pae.

Laau lapaau
I nā makahiki he 20 i hala iho nei, ua hoʻololi nui ʻia ke ʻano o nā lāʻau lapaʻau hypnotic ma ʻAmelika Hui Pū ʻIa. Ke hoʻomau nei ka emi ʻana o ka nui o nā agonist receptor benzodiazepine, ʻoiai ke hoʻonui nei ka nui o ka trazodone, ʻoiai ʻaʻole i helu ka US Food and Drug Administration (FDA) i ka insomnia ma ke ʻano he hōʻailona no ka trazodone. Eia kekahi, ua hoʻokuʻu ʻia nā antagonists mea hoʻopiʻi suppressant i ka makahiki 2014 a ua hoʻohana nui ʻia.

ʻO ka nui o ka hopena o ka lāʻau lapaʻau hou (ka lōʻihi o ka lāʻau lapaʻau, <4 pule) ma ka hopena mua e wehewehe ʻia ma o nā unahi loiloi maʻi, me ka Insomnia Severity Index, Pittsburgh Sleep Quality Index, Leeds Sleep Questionnaire, a me Sleep Diary. Manaʻo ʻia ka nui o ka hopena o 0.2 he liʻiliʻi, ka nui o ka hopena o 0.5 i manaʻo ʻia he haʻahaʻa, a ʻo ka nui o ka hopena o 0.8 i manaʻo ʻia he nui.

ʻO nā pae hoʻohālikelike Beers (kahi papa inoa o nā lāʻau i manaʻo ʻia ʻaʻole kūpono no nā poʻe maʻi 65 a ʻoi paha) e ʻōlelo e pale i ka hoʻohana ʻana i kēia lāʻau lapaʻau.

ʻAʻole ʻae ʻia ka lāʻau lapaʻau e ka FDA no ka mālama ʻana i ka insomnia. Hoʻokaʻawale ʻia nā lāʻau lapaʻau āpau i helu ʻia ma ka papa ma ke ʻano he Pregnancy Class C e ka US FDA, koe wale nō nā lāʻau lapaʻau penei: Triazolam a me Temazepam (Class X); Clonazepam (Papa D); ʻO ka diphenhydramine a me ka docetamine (papa B).
1. Benzodiazepine receptor agonist class hypnotic lāʻau lapaʻau
ʻO nā lāʻau lapaʻau benzodiazepine receptor agonists me nā lāʻau benzodiazepine a me nā lāʻau lapaʻau non benzodiazepine (ʻike pū ʻia ʻo Z-class drugs). Ua hōʻike ʻia nā hoʻokolohua lapaʻau a me nā meta-analyses e hiki i ka benzodiazepine receptor agonists ke hoʻopōkole maikaʻi i ka manawa hiamoe, hoʻemi i ka hoʻāla ʻana ma hope o ka hiamoe, a hoʻonui iki i ka lōʻihi o ka hiamoe (Papa 4). Wahi a nā hōʻike maʻi, ʻo nā hopena ʻaoʻao o ka benzodiazepine receptor agonists e pili ana i ka anterograde amnesia (<5%), ka hoʻomaha ʻana i ka lā aʻe (5% ~ 10%), a me nā ʻano paʻakikī i ka wā hiamoe e like me ka moe ʻana, ka ʻai ʻana, a me ke kaʻa ʻana (3% ~ 5%). ʻO ka hopena hope loa ma muli o ka ʻōlelo hōʻike pahu ʻeleʻele o zolpidem, zaleplon, a me escitalopram. ʻO 20% a 50% o nā maʻi e ʻike i ka hoʻomanawanui ʻana i ka lāʻau a me ka hilinaʻi physiological ma hope o ka lawe ʻana i ka lāʻau lapaʻau i kēlā me kēia pō, i hōʻike ʻia e like me ka rebound insomnia a me ka withdrawal syndrome.

2. Nā lāʻau hoʻomaha heterocyclic
ʻO nā antidepressants sedative, me nā lāʻau tricyclic e like me amitriptyline, demethylamine, a me doxepin, a me nā lāʻau heterocyclic e like me ka olanzapine a me trazodone, ʻo ia ka mea maʻamau i kuhikuhi ʻia i nā lāʻau lapaʻau no ka mālama ʻana i ka insomnia. ʻO doxepin wale nō (3-6 mg i kēlā me kēia lā, lawe ʻia i ka pō) i ʻae ʻia e ka US FDA no ka mālama ʻana i ka insomnia. Hōʻike nā hōʻike o kēia manawa e hiki i nā antidepressants sedative ke hoʻomaikaʻi i ka maikaʻi o ka hiamoe, ka maikaʻi o ka hiamoe, a hoʻolōʻihi i ka lōʻihi o ka hiamoe, akā he liʻiliʻi ka hopena i ka lōʻihi o ka hiamoe. ʻOiai ʻaʻole papa inoa ka US FDA i ka insomnia ma ke ʻano he hōʻailona no kēia mau lāʻau lapaʻau, makemake pinepine nā kauka a me nā mea maʻi i kēia mau lāʻau lapaʻau no ka mea ua loaʻa iā lākou nā hopena haʻahaʻa ma nā haʻahaʻa haʻahaʻa a ua hōʻike ka ʻike lapaʻau i ko lākou pono. ʻO nā hopena ʻaoʻao e pili ana i ka sedation, ka waha maloʻo, ka hoʻopaneʻe ʻana o ka naʻau, hypotension, a me ke kiʻekiʻe.

3. ʻO nā mea kū'ē i ka makemake
ʻO nā neurons e loaʻa ana i ka orexin i ka hypothalamus lateral e hoʻoulu i ka nuclei i loko o ka lolo a me ka hypothalamus e hoʻoikaika i ka ala ala, a ke kāohi i ka nuclei ma ka ventral lateral a me nā wahi preoptic medial e hāpai i ka hiamoe. ʻO ka mea ʻē aʻe, hiki i nā mea hoʻopiʻi ʻai ke keʻakeʻa i ka hoʻokele nerve, hoʻopau i ka ala ala, a hoʻoikaika i ka hiamoe. Ua ʻae ʻia e ka US FDA no ka mālama ʻana i ka insomnia ʻekolu mau mea hoʻopalekana o ka orexin receptor antagonists (sucorexant, lemborxant, a me daridorexint). Kākoʻo nā hoʻokolohua lapaʻau i ko lākou pono i ka hoʻomaka ʻana o ka hiamoe a me ka mālama ʻana. ʻO nā hopena ʻaoʻao e pili ana i ka sedation, ka luhi, a me ka moeʻuhane ʻino. Ma muli o ka hemahema o nā hormones endogenous appetite, hiki ke alakaʻi i ka narcolepsy me ka cataplexy, ua contraindicated nā antagonist hormone appetite i kēlā mau maʻi.

4. Melatonin a me melatonin receptor agonists
ʻO Melatonin kahi hormone i huna ʻia e ka pineal gland ma lalo o nā pōʻeleʻele. Hiki i ka exogenous melatonin ke hōʻea i ke koko ma mua o nā pae physiological, me nā lōʻihi like ʻole e pili ana i ke ʻano kikoʻī a me ka hoʻokumu ʻana. ʻAʻole i hoʻoholo ʻia ke ʻano kūpono o ka melatonin no ka mālama ʻana i ka insomnia. Ua hōʻike ʻia nā hoʻokolohua i hoʻopaʻa ʻia e pili ana i nā pākeke he hopena liʻiliʻi ka melatonin i ka hoʻomaka ʻana o ka hiamoe, me ka ʻaneʻane ʻaʻohe hopena i ka wakefulness i ka wā hiamoe a me ka lōʻihi o ka hiamoe. Ua ʻae ʻia nā lāʻau lapaʻau e hoʻopaʻa i ka melatonin MT1 a me MT2 no ka mālama ʻana i ka insomnia refractory (ramelteon) a me ka circadian sleep wake disorder (tasimelteon). E like me ka melatonin, aneane ʻaʻohe hopena o kēia mau lāʻau i ka ala ala a i ʻole ka lōʻihi o ka hiamoe ma hope o ka hiamoe ʻana. ʻO ka hiamoe a me ka luhi ka hopena maʻamau.

5. Nā lāʻau lapaʻau ʻē aʻe
ʻO nā lāʻau antihistamines i nā lāʻau lapaʻau ma luna o ke kūʻai aku (diphenhydramine a me docetamine) a me nā lāʻau i kuhikuhi ʻia (hydroxyzine) nā lāʻau lapaʻau maʻamau i hoʻohana pinepine ʻia. He nāwaliwali nā ʻikepili e kākoʻo ana i kona pono, akā ʻo ko lākou hiki a me ka ʻike palekana i nā maʻi ke kumu o ko lākou kaulana i hoʻohālikelike ʻia me nā agonists receptor benzodiazepine. Hiki i nā antihistamines sedative ke hoʻoulu i ka hoʻomaha nui, nā hopena ʻaoʻao anticholinergic, a hoʻonui i ka pilikia o ka dementia. Hoʻohana mau ʻia ʻo Gabapentin a me pregabalin no ka mālama ʻana i ka ʻeha mau loa a ʻo ia hoʻi nā lāʻau lapaʻau mua no ka maʻi ʻeha wāwae ʻole. He hopena koʻikoʻi kēia mau lāʻau, hoʻonui i ka hiamoe nalu lohi, a hoʻohana ʻia no ka mālama ʻana i ka insomnia (ma waho aʻe o nā hōʻailona), ʻoi aku ka nui o ka wā i hele pū ʻia me ka ʻeha. ʻO ka luhi, ka hiamoe, ka noʻonoʻo, a me ka ataxia ka hopena maʻamau.

ʻO ke koho ʻana i nā lāʻau hypnotic
Inā koho ʻia ka lāʻau lapaʻau no ka mālama ʻana, ʻo nā agonist receptor agonist benzodiazepine pōkole, orexin antagonists, a i ʻole nā ​​lāʻau heterocyclic haʻahaʻa haʻahaʻa nā koho mua kūpono i ka hapa nui o nā kūlana lapaʻau. ʻO Benzodiazepine receptor agonists paha ka lāʻau maikaʻi loa no nā poʻe maʻi insomnia me nā hōʻailona hoʻomaka hiamoe, nā poʻe maʻi ʻōpio, a me nā poʻe maʻi e koi ana i ka lāʻau no ka wā pōkole (e like me ka insomnia ma muli o nā pilikia koʻikoʻi a i ʻole ka manawa). I ka mālama ʻana i nā maʻi me nā hōʻailona e pili ana i ka mālama ʻana i ka hiamoe a i ʻole ke ala ala ʻana, ʻo ka poʻe ʻelemakule, a me ka poʻe me nā maʻi hoʻohana lāʻau a i ʻole ka hiamoe hiamoe, nā lāʻau heterocyclic haʻahaʻa a i ʻole nā ​​​​mea hoʻopau makemake paha ke koho mua.

Wahi a nā pae hoʻohālikelike Beers, ʻo ka papa inoa o nā lāʻau lapaʻau i kūpono ʻole i nā maʻi i piha i ka makahiki 65 a ʻoi paha ka benzodiazepine receptor agonists a me nā lāʻau heterocyclic, akā ʻaʻole i hoʻokomo i nā antagonists doxepin, trazodone, a i ʻole orexin. ʻO ka lāʻau lapaʻau mua maʻamau ka lawe ʻana i ka lāʻau lapaʻau i kēlā me kēia pō no 2-4 pule, a laila loiloi hou i nā hopena a me nā hopena ʻaoʻao. Inā makemake ʻia ka lāʻau lapaʻau lōʻihi, e paipai i ka lāʻau lapaʻau intermittent (2-4 manawa o ka pule). Pono e alakaʻi ʻia nā maʻi e lawe i ka lāʻau lapaʻau 15-30 mau minuke ma mua o ka moe. Ma hope o ka lāʻau lapaʻau lōʻihi, hiki i kekahi poʻe maʻi ke hoʻomohala i ka hilinaʻi lāʻau, ʻoi loa ke hoʻohana ʻana i nā agonists receptor benzodiazepine. Ma hope o ka hoʻohana lōʻihi ʻana, hiki i nā hōʻemi i hoʻolālā ʻia (e like me ka hōʻemi 25% i kēlā me kēia pule) hiki ke kōkua i ka hōʻemi a i ʻole ka hoʻopau ʻana i nā lāʻau lapaʻau hypnotic.

ʻO ka koho ma waena o ka hui pū ʻana a me ka monotherapy
Ua hōʻike ʻia kekahi mau haʻawina hoʻohālikelike poʻo i ke poʻo i ka wā pōkole (4-8 mau pule), ʻo CBT-I a me nā lāʻau hypnotic (ʻoi aku ka nui o nā lāʻau lapaʻau Z-class) i nā hopena like i ka hoʻomaikaʻi ʻana i ka hoʻomau ʻana o ka hiamoe, akā hiki i ka lāʻau lapaʻau ke hoʻonui nui i ka lōʻihi o ka hiamoe e hoʻohālikelike ʻia me CBT-I. Ke hoʻohālikelike ʻia me ka hoʻohana ʻana i ka CBT-I wale nō, hiki i ka hui hui ke hoʻomaikaʻi wikiwiki i ka hiamoe, akā e emi mālie kēia pōmaikaʻi i ka pule ʻehā a ʻelima paha o ka mālama ʻana. Eia hou, ke hoʻohālikelike ʻia me ka lāʻau lapaʻau a i ʻole ka hui pū ʻana, me ka hoʻohana ʻana iā CBT-I wale nō e hiki ke hoʻomaikaʻi i ka hiamoe me ka hoʻomau. Inā loaʻa kahi ala ʻoi aku ka maʻalahi o ka lawe ʻana i nā lāʻau hiamoe, hiki ke emi mai ka mālama ʻana o kekahi poʻe maʻi i nā ʻōlelo aʻo.