Primäre Insomnie

In Anbetracht sehr häufiger Klagen über Schlafstörungen und der Vielzahl verschiedener Medikamente zur Beeinflussung des Schlafs stellt sich die Frage nach der Relevanz von Schlafstörungen und den Mechanismen, mit denen Schlaf gesteuert wird. Und um Schlafstörungen einordnen zu können, muss die Funktion des Schlafs verstanden sein, über die es in den letzten Jahren einige relevante neue Erkenntnisse gegeben hat. Nur mit diesem Wissen kann man die optimale Therapie von Schlafstörungen auswählen.

Kernaussagen

• Neue Erkenntnisse zur Funktion des Schlafes zeigen, dass Schlaf keineswegs ein passiver Ruhezustand ist.

• Relevante Schlaffunktionen beinhalten die metabolische und immunologische Homöostase, Reinigungsfunktion und Synapsenpflege/Stabilisierung von Lernvorgängen.

• Schlafstörungen haben durch Störung der Schlaffunktion metabolische und immunologische Folgen, etwa verschlechterte Gedächtnisfunktion und vermindertes Abräumen von (teilweise toxischen) Stoffwechselprodukten.

• Wichtigster Störfaktor bei primärer Insomnie ist das kortikale Hyper-Arousal.

• Die Kognitive Verhaltenstherapie des Schlafs (KVT-I) ist die erstrangige Behandlungsempfehlung.

• Die medikamentöse Insomnietherapie beinhaltet immer das Risiko der Gewöhnung.

• Bei der Insomnietherapie macht es Sinn, auf die qualitative Funktion des Schlafs und nicht nur auf quantitative Parameter abzuzielen.

Schlüsselwörter

Schlaflosigkeit - Schlafstörung - Schlafmedizin - primäre Insomnie

Publication History

Article published online:
03 June 2025

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