安眠藥的正確食用方法
楊惟婷整理
長期失眠會影響工作及生活品質，使人感到憂鬱、焦慮、煩躁不安，甚至會容易發生意外，所以需要大家的重視。
台灣有600萬人有不同程度的睡眠障礙，根據衛生福利部食品藥物署的統計，國人每年服用超過3億顆安眠藥。很多人長年靠安眠藥才能睡，濫用安眠藥的問題令人憂心。
一、不當使用安眠藥檢定
您有沒有不當使用安眠藥，可以從使用劑量和時間兩方面初步評估︰
◎時常超過建議劑量
如果時常吃超過醫師建議的劑量，比如醫師建議一次吃一顆，病人自己增加半顆或一顆；醫師建議一週吃5天，病人自行改成每天吃，就可能潛藏濫用的風險。
◎用藥時間不對
有些安眠藥除了幫助睡眠，還有鎮靜、減輕焦慮、放鬆肌肉的效用，於是很多人自行改到白天吃，以應付生活壓力，睡前反而不一定吃，這也是濫用的現象。
二、失眠可能只是各種疾病各種疾病冰山一角
失眠可能是其他因素引起的，或是各種疾病的冰山一角。
造成長期失眠的生理、心理因素很多，最常見的是憂鬱症。
安眠藥的建議劑量是設計給沒有其他疾病、只是單純失眠的人用的，如果本來只是單純失眠，後來卻出現憂鬱症或者其他身體不適（如心臟疾病、胃食道逆流、疼痛、更年期等），或是本來就有憂鬱症而不自知（80％的憂鬱症患者會失眠），都會加重失眠，原來的藥物劑量就發揮不了效果。
安眠藥愈吃愈多，不一定代表藥物上癮，可能是病情已經出現變化，或者沒有找到失眠的根本原因。
如果安眠藥的效果一直不錯，但最近效果愈來愈差、吃了還是睡不著，就是警訊，表示造成失眠的原因可能改變了，一定要再度就醫評估，先治療根本的疾病，睡眠才有機會改善，而不是自行加藥。
如果找不到其他身心疾病引起失眠，可能表示體質不適合長期吃安眠藥，建議學習非藥物療法如放鬆技巧等來改善睡眠。
三、吃安眠藥到底會不會上癮？
作家鍾怡雯曾受失眠之苦，她在《垂釣睡眠》一書中寫出失眠的痛苦、面對藥物的掙扎︰「我聽上癮的人說它是嗎啡，讓人既愛又恨，明知傷身，卻又拒絕不了，因為無它不成眠。」
至於吃安眠藥會不會變得長期依賴安眠藥，不吃就睡不著？
如果80％的人失眠超過一年、60％的人失眠超過5年，說明失眠經常慢性化，變成慢性病，就像高血壓、糖尿病一樣需要長期治療，因此學會照顧好睡眠的長期保養之道，才是比較合理的治療目標。
只要在醫師指導下使用安眠藥，不需要太擔心會上癮。因為經常睡不著，卻沒有好好治療，可能會讓其他疾病惡化，得不償失。
但長期治療不代表長期用藥。藥物只是治療方式之一，適度使用安眠藥，維持睡眠品質、促進整體健康，是權衡是否使用藥物的關鍵。
四、不吃藥也能一夜好眠
其實很多大量吃安眠藥的人也自覺到藥愈吃愈多，也不想一直這樣下去，但想到每晚在床上翻來覆去「煎魚」、數羊，盯著天花板到天明，「算了，還是吞顆藥解決痛苦吧，其他事以後再說。」
想擺脫過度依賴安眠藥，需要自己下點功夫︰
■先意識到安眠藥有記憶力衰退、注意力不集中的副作用
長庚醫院睡眠中心臨床心理師吳家碩說，安眠藥可以讓人睡著，但不一定睡得深，不像自然的睡眠可以讓人熟睡、醒來後元氣飽滿。
而且長期、大量吃安眠藥，恐怕有記憶力衰退、注意力不集中的副作用。
■學習非藥物療法
如果擔心太依賴藥物，可以同時學習非藥物療法。只要好好練習，非藥物療法可以有效改善失眠、減少藥物用量，還可防止偶發性失眠變成慢性失眠。
方法如下︰
◎規律的作息時間
不管夜裡睡得好不好、睡多久，盡量固定早上起床時間，不要因為失眠就用白天補眠。
◎創造睡意
˙如有失眠困擾，盡量不要午睡，避免用掉晚上的睡眠能量。
˙黃昏時做有氧運動，可創造更多的睡眠能量。
◎刺激控制法，讓人倒頭就睡
良好的睡眠習慣就是要讓床跟睡眠產生制約連結，一上床就想睡。
但很多人不知不覺養成不利睡眠的刺激連結，比如在床上看書、滑手機、看電視，結果床不再跟睡眠產生連結，上床後身體直接的反應是清醒、興奮，當然難以入睡。
因此，刺激控制法就是要重新建立床跟睡覺的連結︰
˙不在床上做跟睡覺無關的事。
˙有睡意時再上床，如果不睏，不要上床等睡意降臨。
˙躺了20～30分鐘還睡不著，不要一直翻來覆去，否則身體會跟床產生負面的連結，一上床就想到失眠。起來去做點靜態的事，有睡意再躺回床上。
◎放鬆減壓，啟動睡意
很多人失眠是因為無法解除白天的緊張、焦慮，到了晚上仍然緊繃、清醒，需要藉放鬆訓練來幫助睡眠。
放鬆訓練怎麼做？睡前找一處安靜的地方（不建議躺在床上做，因床的功用是睡覺），做20～30分鐘的放鬆訓練，然後帶著睡意上床。包括︰
˙腹式呼吸︰
慢慢、深深地吸氣，讓氣往下走，直到腹部微微鼓起，肩膀不聳起，然後慢慢吐氣（最好練到吸氣的兩倍長）。這樣可以啟動副交感神經，讓心跳和緩下來，人得以放鬆。
˙肌肉放鬆︰
比如想放鬆肩膀，就先聳肩、繃緊肌肉數秒，然後慢慢鬆開。身體其他部位也可用這個方法放鬆。全身放鬆、柔軟，會更容易進入夢鄉。
˙冥想︰
播放輕音樂，然後想像自己置身一處喜歡的地方（比如海邊、森林）。也可以藉精油的芳香營造舒緩的睡前氛圍。
部份醫院開設失眠者的團體治療，會教放鬆技巧，可考慮參加。
學會非藥物療法，就有條件減少藥物、甚至不靠藥物也能睡。很多病人在運用這套方法後可以不吃藥也睡得著，並找回對睡眠的信心。
■了解安眠藥的特性，慢慢減藥
苯二氮平類的安眠藥（常見商品如「悠樂丁」、「戀多眠」、「樂得眠」等）除了可以安眠，還有部份肌肉放鬆、抗癲癇、抗焦慮的效果，如果已較大量吃這些藥一段時間，突然快速減藥，藥物的效果沒了，身體會出現戒斷症狀，比如煩躁、緊繃、反彈性失眠（失眠比原先更嚴重）、多夢等，很多人受不了，加回原來劑量，等於又被安眠藥綁住了。
新一代的非苯二氮平類安眠藥（常見商品如「使蒂諾斯」、「宜眠安」、「入眠順」）作用比較專一在睡眠，但大量使用還是有抗焦慮、放鬆肌肉的效果，減藥時也會出現戒斷症狀。
醫師提醒，減藥最重要的原則就是慢慢減，讓身體慢慢適應。建議跟醫師討論怎麼減藥，比如本來一週吃14顆，先減到12顆（有兩天只吃一顆），下一週再減兩顆。絕對不要馬上一顆藥也不吃。
醫師也可能會用其他藥物（如長效鎮靜劑、抗憂鬱劑、抗組織胺等）來取代一部份安眠藥，讓安眠藥可以減量，而且戒斷症狀不會那麼明顯，然後再慢慢減這些替代的藥物。
醫師也提醒，減藥的前一兩星期多少會出現戒斷症狀，不要怕，那只是一個過程。只要減藥的方法正確，都能順利降低藥量。
如果藥物使用量很高，或減藥過程很不舒服，可以考慮住院，醫護人員可以隨時協助。
■建立合理的減藥目標
究竟減藥到什麼程度才算成功？
建議不妨把目標訂在「合理使用」，而非「完全不用」。
就像可以用飲食、運動來控制血壓、血糖，但如果實在降不下來，還是需要藥物。
使用安眠藥可把握「當用則用，當省則省」的原則，平常用非藥物療法助眠，遇到壓力大的時候，也不排斥藥物。偶爾吃，但生活品質跟天天吃一樣好，這是最理想的。
■推翻自己不合理的想法
曾有病人告訴醫生︰「我一星期只吃一顆安眠藥喔。」原來他把安眠藥搗碎，一次只吃一點點。
醫生，說，七分之一的藥量幾乎無效，但病人還是相信有用，恐怕大部份是心理上的依賴。
尤其，錯誤的觀念也會加重失眠和對藥物的依賴。
例如很多失眠者有不合理的想法，如「不吃藥我就睡不著」、「一定要睡8小時才有精神」，這些想法引起錯誤的行為，比如過度依賴藥物，或者睡不著還一直躺在床上，想湊滿8小時，結果愈躺愈焦慮，更睡不著。
此時，可以先做放鬆訓練，然後調整想法，最後才考慮藥物。
其實，對抗失眠的武器很多，善用它們，讓睡神降臨不再是難事。
■安眠藥這樣吃不上癮
林口長庚醫院胸腔內科主治醫師羅友倫在《揭開睡眠的真相》中說︰「想成功戒掉高劑量的安眠藥不會比戒毒更輕鬆。」
林口長庚醫院精神科系主任許世杰提醒，預防勝於治療，與其等到過度依賴安眠藥才想減藥，不如一開始就慎用︰
˙盡量不要每天吃、盡量不要連續吃超過8週。
˙從最低劑量開始吃（通常是一次半顆或一顆），不要自行增加劑量。
˙如果失眠較嚴重，經醫師診斷可連續吃2～3週，睡眠穩定後，建議學習非藥物療法，並跟醫師討論減藥。
˙偶爾遇到壓力大、睡不著，可以吃安眠藥，但要就醫拿藥，不可吃別人的。因為每個人的失眠情形不同，每種藥物的特性也不同，應該經由醫師診斷、開藥。
˙如果安眠藥的效果愈來愈差，應告訴醫師，不要自行多吃。
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