Çocuk ve Ergenlerde Madde veya İlaçların Yol Açtığı Uyku Bozuklukları
Özet
Çocuk ve ergenlerde uyku-uyanıklık döngüsü, hipotalamus ve beyin sapındaki karmaşık nöronal etkileşimlerle kontrol edilmekte olup nörotransmitterleri etkileyen farmakolojik ajanlar bu dengeyi bozabilmektedir. Antidepresanlardan SSRI'lar REM uykusunu baskılayıp uyku bölünmesine yol açarken, sedatif etkili trisiklik antidepresanlar uyku süresini artırabilmektedir. Benzodiazepinler ve antipsikotikler genellikle uyku latansını kısaltıp toplam uyku süresini artırsa da uyku mimarisini değiştirmekte ve gündüz sedasyonuna neden olabilmektedir. DEHB tedavisinde kullanılan stimülanlar uyanıklığı artırıp uykuyu geciktirirken, lityum sirkadiyen ritimleri etkilemektedir. Madde kullanımı cephesinde; alkol, nikotin ve kafein uyku latansını artırıp toplam uyku süresini kısaltırken, esrar ve opioidler hem kullanım hem de yoksunluk evrelerinde ciddi uyku bozukluklarına, anormal rüyalara ve solunum sorunlarına yol açmaktadır. Tanınmayan uyku sorunları ile madde bağımlılığı arasındaki çift yönlü ilişki, gençlerin klinik değerlendirmesinde hayati önem taşımaktadır.
The sleep-wake cycle in children and adolescents is controlled by complex neuronal interactions in the hypothalamus and brainstem, and pharmacological agents affecting neurotransmitters can disrupt this balance. Among antidepressants, SSRIs suppress REM sleep and cause sleep fragmentation, while sedative tricyclic antidepressants may increase sleep duration. Although benzodiazepines and antipsychotics generally shorten sleep latency and increase total sleep time, they alter sleep architecture and can cause daytime sedation. Stimulants used in ADHD treatment increase wakefulness and delay sleep, whereas lithium affects circadian rhythms. Regarding substance use; alcohol, nicotine, and caffeine increase sleep latency and shorten total sleep time, while cannabis and opioids lead to severe sleep disturbances, abnormal dreams, and respiratory issues during both use and withdrawal phases. The bidirectional relationship between unrecognized sleep problems and substance addiction is of vital importance in the clinical evaluation of youth.
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