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毛布
毛布

レム睡眠行動障害の治療前に取り組みたい3つの自宅療法

毛布

レム睡眠行動障害という病気があります。発症は中高年の男性に多く対処療法による治療がメインとなります。現在、日本人の成人男性の4人に1人が睡眠に悩んでいるとも言われており、特に中高年から高齢になるにつれ、その傾向が高いようです。

レム睡眠行動障害は、本来身体の筋肉活動が抑えられているはずの睡眠時に、夢などの夢想状態の中で行動をしてしまうという障害です。レム睡眠行動障害は、投薬による対処治療がメインになりますが、予防や改善に向けて自宅でも取り組めることがあります。レム睡眠行動障害の治療前に自宅でもできる3つの対処治療法をご紹介しましょう。

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レム睡眠行動障害の診断基準とその治療

夜の遊園地

レム睡眠行動障害は、一般的に50歳以降の男性に多く発症するとされています。レム睡眠行動障害そのものが、あまり知られていないために、治療に至る場合も少なく、誤解されやすい睡眠障害でもあります。レム睡眠行動障害は、浅い眠りの状態であるレム睡眠下において起こります。

本来、骨格筋がゆるんで、活動を抑えられているはずのレム睡眠中に、何らかの原因で筋肉の活動を抑える脳機能が働かず、夢と同じように手足を動かしたり、大声を出してしまったりなど、行動に表わしてしまうのです。ひどい場合は、暴力的な動作を行ってしまい、隣に寝ている人を叩いたりしてしまうこともあるようです。このような症状があっても、根本から治療できる方法は現在はなく、投薬などの対処療法が一般的です。

というのも、レム睡眠行動障害の原因ははっきりしておらず様々な要因を言われています。脳炎などの炎症性疾患や、アルコールや薬剤による二次的要因、またストレスや睡眠不足から起こることもあるようです。

レム睡眠行動障害に似ているもので夢遊病があります。しかし、夢遊病とよばれるものは、子供に発症しやすく、また深い眠りの状態であるノンレム睡眠下で起こります。夢遊病のような活動は睡眠時随伴症といい、成長と共に自然に改善することがほとんどです。レム睡眠行動障害は、中高年の男性が発症し、そのうち30%はパーキンソン病やレビー小体型認知症が発症する前触れであるとも言われるため、年齢が高くなるにつれて脳機能の更なる低下が心配される病気なのです。

レム睡眠行動障害へ診断基準

レム睡眠行動障害は治療に至るまでに検査が必要になり、また睡眠外来などの専門医での診断が必要です。その際は、「睡眠障害国際分類第2版」に基づいて診断されることが多いようです。その診断基準は以下の通りです。

A:筋抑制を欠いたレム睡眠が存在する。持続的または間欠的な頤(おとがい)筋活動の更新や、頤筋または四肢の相同的な収縮

B:少なくとも次の1項目が存在する。
1.けがをしてしまうか、あるいはけがをしてもおかしくないような睡眠時の荒々しい行動
2.睡眠ポリグラフ検査中に記録されたREM睡眠時の異常行動

C:レム睡眠中に、てんかん性脳波活動がみられない

D:他の睡眠以上堂では十分説明できない睡眠障害である(内科疾患や神経疾患、精神疾患、薬剤性や薬物乱用による疾患)

特に、睡眠ポリグラフ検査による診断が有効で、特に、一晩かけて検査をする「終夜睡眠ポリグラフィー検査」によって、睡眠の種類や深さ、長さだけでなく、ビデオでの記録によって睡眠中の行動を確認します。

レム睡眠行動障害の専門治療

レム睡眠行動障害と診断されても、睡眠中に手足が軽く動く程度の軽い症状であれば、投薬などの治療までは必要ないと判断されることもあるようです。しかし、睡眠中にひどい暴力を起こしたり、ベットから強く転落するような自傷行為があると、早急な治療の必要があります。

病院での対処療法としての投薬治療は、クロナゼパムが一般的なようです。クロナゼパムはベンゾジアゼピン系の抗てんかん薬になります。ただし、この薬は睡眠時無呼吸がひどくなったり、翌朝にふらつきが出ることもあるため、その他症状の確認など治療に至るまでの専門医の診断が必要になります。

軽い症状の治療には、漢方やサプリメントの利用を勧められることもあるようです。漢方の抑肝散(よくかんさん)子供の夜泣きなどにも使われるもので、不眠などの精神神経症状やけいれんなどの症状にも処方されるものです。また、睡眠導入に働くメラトニンのサプリメントは海外では睡眠障害へのアプローチとしては一般的です。軽度の症状であれば、より穏やかな処方によって治療を勧める場合もあるようです。

レム睡眠行動障害の自宅治療

レム睡眠行動障害を治療するためには、家族からの保護や確認が必要になってきます。本人の自覚がないために、睡眠時の周囲の環境を整備したり、より安全な睡眠に導かれるような準備が必要なのです。同時に、自宅でできる範囲の治療を行うことが大切です。レム睡眠行動障害については、寝室を共にする人が一番最初に気が付くはずです。ちょっと気になるなと思ったら、治療を始める前に、自宅でも睡眠の質を改善させるための自宅療法を行うようにしましょう。

レム睡眠行動障害の治療前に取り組みたい3つの自宅療法があります。

  • 寝酒の習慣があれば止める
  • ストレスケアを勧める(夜のリラックス時間の確保に協力する)
  • ビタミンB群を摂取する

この3点は、今すぐからでもできる睡眠の質改善、そしてレム睡眠行動障害を緩和させるための自宅療法になります。

まず、レム睡眠行動障害は、お酒によって誘発されることが多いことがわかっています。特に、長期間の寝酒が習慣になっている場合、段々と飲酒量が増え、脳機能への悪影響が大きくなります。治療のためには禁酒を行うのが一番ですが、そのためには家族の協力が必要になります。実際に専門医での治療を始めたとしても、寝酒を減らすように指示されると思います。すでに、大声で寝言を言うなどの症状が気になっているのであれば、レム睡眠行動障害が悪化する前に、予防としての禁酒を勧めましょう。

寝る前のストレスケアもとても大切です。夜に興奮すると、症状が悪化しやすくなります。ストレスケアを行うためにも、家族みんなでテレビを消し、楽しく話す、静かに過ごすなどの時間を設けましょう。夜のリラックスした時間によって、穏やかな睡眠状態を作りやすくします。

最後に、ビタミンB群の摂取をお勧めします。レム睡眠行動障害は、その症状からパーキンソン病や認知症などとの関連が強いとされています。特に、レム睡眠行動障害発症後、その30%がパーキンソン病などに移行することを考えると、対策を事前に行うことこそが有効な予防策だと考えられます。ビタミンB群はビタミンB1~12、葉酸、パントテン酸などを含み、神経系に働くビタミンであり、代謝に必要なビタミンでもあります。英オックスフォード大学での研究では、葉酸とビタミンB6、B12の摂取が脳の萎縮を遅らせるとの結果を発表されています。また、京都大学医学部老年科の亀山教授の研究によると、老人性認知症患者の脳と健康な老人の脳と比較すると、含まれるビタミンB12が1/4~1/6程度にまで、低下していたと報告されています。ビタミンBは葉酸などの単体では働かず、それぞれが相互作用を起こしています。できるだけ複合体のビタミンB群を摂取することで、予防や改善につながる可能性が高くなります。食事としては豚肉に多く含まれ、マグロやウナギなどにも含まれます。神経系に働くB12はレバーなどの動物性食品に多く含まれます。サプリメントで利用する場合は、できるだけ天然素材のものを利用しましょう。

まとめ

レム睡眠行動障害は、本人の自覚がないために治療へと進みにくいものです。暴力的な行為などがなくても、睡眠時の異常行動を確認したら、出来るだけ早く専門医への治療を勧めましょう。軽度であれば対応もしやすいものですが、そこから認知症などが発症してしまうと家族の負担も増えてしまいます。レム睡眠行動障害があると本人も良く眠れていないはずです。早期治療こそがカギになりますが、理解を得るためにも、まずは自宅でできることから始めてみましょう。

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