Insomnia sebagai Salah Satu Jenis Gangguan Tidur.doc

8/19/2019 Insomnia sebagai Salah Satu Jenis Gangguan Tidur.doc

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Insomnia sebagai Salah Satu Jenis Gangguan TidurIvanalia Soli Deo 102012359

C7

FAKULTAS KEDOKTERAN

UNIVERSITAS KRISTEN KRIDA WACANA

Koe!"on#en$ ivanalia%#eo&'(ail%)o(

Pendahuluan

Sala* !a+, -e'ia+an .an' "en+in' ,n+,- #ila-,-an ole* !e(,a oan' a#ala* +i#,%

Ti#, "en+in' ,n+,- (en/a'a -e!e*a+an ,n'!i e(o!ional #an /,'a (en+al% In!o(nia

a#ala* !ala* !a+, 'an'',an +i#, .an' an.a- #iala(i ole* (a!.aa-a+ !aa+ ini%

an'',an ini "alin' +i#a- "ena* #i#ei+a ole* !e!eoan' "alin' +i#a- !e-ali #ala(

*i#,"n.a a+a, a*-an *a("i #i !e"an/an' *i#,"n.a% Se!eoan' .an' +e'an'',

+i#,n.a #a"a+ (e(,a+ -,ali+a! *i#,"n.a (en,,n 4-on!en+a!i (en,,n !elal,

(ea (en'an+,- )e"a+ (aa* #an (en'i#a" ea'ai "en.a-i+%

In!o(nia !en#ii a#ala* 'e/ala -elainan #ala( +i#, e,"a -e!,li+an e,lan'

,n+,- +i#, a+a, ",n (e("e+a*an-an +i#, 6ala,",n a#a -e!e("a+an ,n+,- i+,%

en.ea in!o(nia !an'a+ ea'a( (,lai #ai !+e!! )e(a! 'an'',an e(o!ional

ee- !a("in' oa+ ee- (a-anan a+a, (in,(an 'e/ala "en.a-i+ +e+en+, *in''a

"en'a,* lin'-,n'an% a#a 8L -ali ini #i#a"a+i -a!,! !eoan' la-ila-i e,!ia :5+a*,n .an' #a+an' #en'an -el,*an !,li+ +i#,% 8e#a!a-an -a!,! +e!e,+ a-an

#ia*a! lei* lan/,+ (en'enai i!iolo'i +i#, a-+oa-+o "en.ea in!o(nia #an

/,'a "ena+ala-!anaann.a%

Pembahasan

Fisiologi Tidur 1

Fi!iolo'i +i#, #a"a+ #i+ean'-an (elal,i 'a(aan a-+ivi+a! !el!el o+a- !ela(a

+i#,% A-+ivi+a! +e!e,+ #a"a+ #ie-a( #ala( ala+ EE% Un+,- (ee-a( +i#, )aa

.an' #i"a-ai a#ala* #en'an EE Polygraphy% Den'an )aa ini -i+a +i#a- !a/a

(ee-a( 'a(aan a-+ivi+a! !el o+a- 4EE +e+a"i /,'a (ee-a( 'ea- ola (a+a

4EO #an +on,! o+o+ 4E;% Un+,- EE ele-+o#a *an.a #i+e("a+-an "a#a #,a

#aea* !a/a .a-ni #aea* on+o!en+al #an o-!i"i+al% elo(an' Ala "alin' /ela!

+eli*a+ #i #aea* on+al% #a"a+-an : /eni! 'elo(an' .ai+,$ 'elo(an' ala

'elo(an' e+a 'elo(an' +e+a #an 'elo(an' #el+a%

a#a !+a#i,( /a'a 4!+a#i,( W < 6a-e 'a(aan EE #i#o(ina!i ole*'elo(an' Ala% a#a EO ia!an.a #i#a"a+i 'ea-an (a+a .an' e-,an'% a#a

1



E; #i#a"a+i +on,! o+o+ (enin''i% ;e(a!,-i !+a#i,( 1 ia!an.a 'a(aan EE

a-an (e("eli*a+-an 'elo(an' )a(",an Ala 8e+a #an -a#an'-a#an' Te+a%

A-+ivi+a! ola (a+a .an' )e"a+ +i#a- +eli*a+ la'i #an +on,! o+o+ (,ai (en,,n

#ian#in'an "a#a !+a#i,( W% a#a !+a#i,( 2 'elo(an' )a(",an .an' +e#ii #ai

ala +e+a #an #el+a (,lai +eli*a+ "a#a EE% Ka#an'-a#an' a-an +eli*a+ "enin'-a+an

+on,! o+o+ !e)aa +ia+ia *al ini (en,n/,--an a*6a o+o+o+o+ +oni- el,(

!el,,*n.a #ala( -ea#aan ela-!% S+a#i,( 3 'a(aan +on,! o+o+ .an' lei* /ela! #ai

!+a#i,( 2% S+a#i,( : +on,! o+o+ (en,,n #ai "a#a !+a#i,( !eel,(n.a% S+a#i,(

RE; "a#a EE +eli*a+ 'elo(an' )a(",an ala e+a #an +e+a% Ti#a- +e#a"a+

'elo(an' #el+a% Teli*a+ 'a(aan RE; 4a"i# e.e (ove(en+ .an' -*a!% Ton,!

o+o+ "a#a !+a#i,( ini !an'a+ en#a*%

a#a -on#i!i no(al !eoan' #e6a!a (e(a!,-i !+a#i,( 1 #an 2 #en'an )e"a+

#an (e(",n.ai !+a#i,( +i#, #ala( 4!+a#i,( 3 #an : .an' e-i!a an+aa 70 100

(eni+% Se+ela* i+, +i(,lla* !+a#i,( RE; .an' 'a(aan EE n.a (ii" #en'an

!+a#i,( +i#, .an' #an'-al% Ke/a#ian a+a, !i-l,! ini e,lan' #en'an in+eval 6a-+,

90 (eni+% Se(a-in (en#e-a+ -e "a'i *ai +i#, .an' #ala( !e(a-in e-,an' #an

+i#, RE; !e(a-in e+a(a*% Dala( -on#!i no(al +e/a#i : = > -ali "eio#e +i#,

RE;% Se)aa -e!el,,*an "eio#e +i#, RE; (eli",+i 25? #ai -e!el,,*an +i#,%

ola *i"no'a( ini #i"en'a,*i ole* ,!ia% a#a ana-ana- !+a#i,( 3 #an : (eli",+i

/,(la* .an' lei* e!a #ai "a#a #e6a!a no(al #an (a-in e-,an' la'i "a#a ,!ia

lan/,+%

a(a 1 a(aan Si-,! Ti#, No(al

2



Anamnesis

Ana(ne!i! #ila-,-an !e)aa a,+oana(ne!i! 4(enan.a-an lan'!,n' -e"a#a

"a!ien a+a,",n alloana(ne!i! 4(enan.a-an -e"a#a oan'+,a@oan' +e#e-a+ -aena

"a!ien #ala( -on#i!i +i#a- (a(", (e(ei-an /a6aan% Se!,ai #en'an -a!,!

"e+an.aan .an' #ia/,-an #a"a+ (eli",+i i#en+i+a! #ii -el,*an ,+a(a !e/a- -a"an

-el,*an ,+a(a (,n),l -el,*an lain .an' (,n'-in #ia!a-an i6a.a+ "en.a-i+ .an'

#i#ei+a !aa+ ini i6a.a+ "en.a-i+ #a*,l, i6a.a+ "en.a-i+ -el,a'a "en'oa+an .an'

!,#a* #ila-,-an #an -on#i!i !o!ial e-ono(i "a!ien%

Den'an (enan.a-an i6a.a+ "en.a-i+ .an' #i#ei+a "a!ien !e-aan' a+a, ",n

#i6a-+, lal, -i+a #a"a+ (en'i#en+ii-a!i ea'ai -e(,n'-inan "en.ea #ai

in!o(nia% Se"e+i (i!aln.a "a!ien .an' (en'ala(i (a!ala* -e!e*a+an .an' !,#a*

#i#ei+an.a #ai #,l, a+a, a,a, ini (en'ala(i -e!,li+an +i#, -aena a!an.a

n.ei .an' #i+i(,l-an ole* -aena "en.a-i+n.a a!a (,al ",!in' #an ea'ai

'e/ala lainn.a .an' #ia!a (en''an'',% Oa+oa+an .an' +en'a* #i-on!,(!i "a!ien

/,'a !ein' (en/a#i a-+o "en.ea +e/a#in.a in!o(nia% 8e'i+, ",la #en'an

(a-anan a+a, (in,(an .an' !ein' #i-on!,(!i "a!ien !e"e+i -o"i #an al-o*ol%

en+in' /,'a ,n+,- (en'e+a*,i a"a-a* "a!ien !e#an' #ala( -on#i!i (en+al .an'

+i#a- ai- 4(en'ala(i #e"e!i anie+a! #!%

8ei-,+ ini a#ala* eea"a )on+o* "e+an.aan .an' #a"a+ #ia/,-an -e"a#a "a!ien

"en#ei+a 'an'',an +i#,$ a"a-a* an#a !ein' (ea!a (en'an+,- a+a, +i#, la(a #i

!ian' *aiB Ke!,li+an -on!en+a!i #i !ian' *aiB Tean',n #i (ala( *aiB Tean',n

lei* #ai !a+, -ali "a#a +i#, (ala(B 8ea"a la(a 6a-+, .an' a#a ,+,*-an !eel,(

an#a +e+i#,B 8ea"a la(a 6a-+, an#a +i#, "a#a (ala( *aiB A"a-a* an#a

+ean',n +elal, a6al "a#a "a'i *aiB 8a'ai(ana-a* +i#, (ala( !eel,(

(en'ala(i (a!ala* ini 4la(a +i#, -,ali+a! +i#, #ll%B A#a-a* /a#6al +i#, #an

an',n an#a "a#a *ai (in'', ee#a #ai *ai lainn.aB A#a-a* +e#a"a+ an''o+a

#ala( ,(a* .an' (en''an'', +i#, an#aB

A#a-a* an#a !ein' +ean',n "a#a (ala( *ai #en'an a!a n.ei a+a, +e#a"a+

-e"el,an ,n+,- (en'',na-an -a(a (an#i@WCB A"a-a* "e-e/aan an#a !e-aan'

(en,n+,+ ,n+,- -e/a 'ili 4 shift work a+a, (ean+a, 4travel B A#a-a* an#a

(e(in,( (in,(an .an' (en'an#,n' -aein 4-o"i +e* (in,(an in'anB Selain

'an'',an +i#, a"a-a* /i-a a#a (a!ala* -e!e*a+an lain .an' an#a ala(iB A"a-a*

oa+ +i#, "e!-i"!i a+a, non "e!-i"!i .an' an#a (a-an 4#i+an.a-an ",la #o!i!

3



e-,en!i #an #,a!iB A#a-a* an#a "ena* (en#ei+a #e"e!i an!ie+a! a+a, (a!ala*

.an' !e,"aB A#a-a* an#a #en'-, !aa+ +i#,B

Pemeriksaan Fisik 2

e(ei-!aan i!i- .an' #a"a+ #ila-,-an (eli",+i "e(ei-!aan -e!a#aan #an

-on#i!i ,(,( "a!ien "e(ei-!aan +an#a+an#a vi+al #an "e(ei-!aan !+a+,! (en+al%

e(ei-!aan +an#a+an#a vi+al .an' #a"a+ #ila-,-an (eli",+i$ +e-anan #aa* na#i

e-,en!i na"a! #an !,*, a#an% e(ei-!aan !+a+,! (en+al !eenan.a #a"a+

#ila-,-an e!a(aan #en'an (ela,-an a,+oana(ne!i!% Sela(a (ela-,-an ana(ne!i!

-i+a #a"a+ (eli*a+ a'ai(ana "ena("ilan #ai "a!ien !i-a" )aa e"a-aian "o!+,

+,,* -eei!*an #ii lal, a"a-a* "a!ien +a("a- lei* +,a@(,#a@!e!,ai ,!ian.a%

Lal, "e*a+i-an ",la -,ali+a! ei)aa #ai "a!ien a"a-a* "a!ien #a"a+ ei)aa

!"on+an a+a, (en'ala(i 'an'',an ei)aa 4ei)aa +i#a- /ela! *an.a

(en'el,a-an ,n.i,n.i +an"a a+i ei)aa *al .an' +i#a- !e!,ai aa!ia #!%

e*a+i-an a"a-a* "a!ien (en'ala(i 'an'',an "e!e"!i 4*al,!ina!i il,!i #eeali!a!i

a+a,",n 'an'',an "o!e! "i-i 46a*a(% La-,-an "e(ei-!aan !en!oi,( #an -o'ni!i

/i-a #i),i'ai "a!ien (en'ala(i 'an'',an ,n'!i in+ee-+,al #an -on!en+a!i%

Pemeriksaan Penunjang

1. Pemeriksaan Elektroensefalografi EEG!3

e(ei-!aan ini a#ala* "o!e#, "en)a+a+an a-+ivi+a! li!+i- o+a- #en'an ala+

"en)a+a+an .an' "e-a% EE ini (enan'-a" 'elo(an' li!+i- .an' #i*a!il-an ole*

"e(,-aan 4!el!el -o+e-!% Dai -e+i'a /eni! !el -o+i-al !el ".a(i#alla* .an'

#ian''a" (e,"a-an !,(e "o+en!ial li!+i- #ai 'elo(an''elo(an' "e(,-aan%

A#a",n 'elo(an' "e(,-aan i+, (e,"a-an "en/,(la*an #ai "o+en!ial li!+i-

"a!)a !ina"! ai- .an' e!ia+ in*iii!i a+a, e-!i+a!i .an' ea!al #ai !o(a #an#en#i+#en#i+ e!a !el ".a(i#al .an' -e(,#ian (elal,i )aian #an /ain'an +,,*

!a("ai "a#a ele)+o#eele-+o#e EE%

8ea'ai "eneli+ian (en',n'-a"-an +i#a- !e(,a in#ivi#, no(al

(e("eli*a+-an EE .an' no(al #an +i#a- !e(,a ano(ali+a! #ala( EE ea+i

a#a ano(ali+a! "a#a in#ivi#, .an' e!an'-,+an% A-+ivi+a! ano(al #i!e,+

!"e!ii- ila 'elo(an' .an' +i(,l (e(",n.ai 'a(aan .an' -*a! #an e-oela!i

+in''i #en'an -elainan -lini- +e+en+,% e(ei-!aan EE "en+in' ,n+,-$ (en#ia'no!a

#an (en'-la!ii-a!i-an e"ile"!. ,n+,- #ia'no!a #an lo-ali!a!i +,(o ,n+,- #ia'no!a

4



le!i #e!a- ,an' lain "a#a ,#a"a-!a -e"ala "a#a ine-!i o+a- "a#a -elainan

(e+aoli) ele-+oli+%

2. Pemeriksaan "aboratorium

e(ei-!aan ini !eenan.a lei* #i+,/,-an ,n+,- (en'e+a*,i e+iolo'i #ai

in!o(nia% ;i!aln.a a"aila "a!ien in!o(nia (e(ili-i i6a.a+ OK (a-a "a!ien

*a,! (e(ili-i *a!il +e! 'a! #aa* a+ei ,n+,- (enen+,-an a"a-a* (ee-a

*."oe(i)% i-a #i#a"a+i a*6a "a!ien (en'ala(i *."oe(i) (a-a "en'oa+an

#en'an o-!i'en #a"a+ (e("eai-i na(,n (e(an' +i#a- (en'*ilan'-an in!o(nia%

#. A$tigra%h&

A)+i'a"*. a#ala* +e! lain .an' lei* o/e-+i .an' (,n'-in #ila-,-an #ala(

!i+,a!i +e+en+, +e+a"i +i#a- !e)aa ,+in a'ian #ai eval,a!i ,n+,- in!o(nia% A)+i'a"*

a#ala* !e,a* #e+e-+o 'ea-an 'ea-an .an' in#ea !e!eoan' !aa+ +i#, #an +e/a'a%

al ini #i"a-ai (ii" #en'an /a( +an'an !ela(a e*ai*ai -e (in'', #an #a+a

"e'ea-an #i)a+a+ #an #ianali!a ,n+,- (enen+,-an "ola +i#, #an 'ea-an% Te! ini

(,n'-in e',na #ala( -a!,! 'an'',an in!o(nia "i(e 'an'',an ia(a !i-a#ian

a+a, -e!ala*"a*a(an +i#, ne'aa%3

a(a 2% A)+i'a"*.

'. (iari Tidur

Diai +i#, *a,! #ii!i ole* "a!ien !e+ia" *ai !ela(a 2 (in'',% a!ien #i(in+a

,n+,- (en,li! 6a-+, !e+ia" -ali (ee-a "e'i -e +e("a+ +i#, +e+i#, +e/a'a #ai

+i#, +e+a" +e/a'a #i +e("a+ +i#, #an an',n #i "a'i *ai% Selain i+, /,(la* la+i*an

5



!e*ai*ai "en'a(ilan al-o*ol #an -aein !e+a oa+oa+an #a"a+ /,'a #ii!i #ala(

#iai +e!e,+%

a(a 3% Diai +i#, 2

Insomnia

In!o(nia a#ala* !a+, #ai eea"a /eni! 'an'',an +i#,% In!o(nia a#ala* 'e/ala

-elainan #ala( +i#, e,"a -e!,li+an e,lan' ,n+,- +i#, a+a, ",n (e("e+a*an-an

+i#, 6ala,",n a#a -e!e("a+an ,n+,- i+,% I!+ila* lain .an' #a"a+ #i',na-an a#ala*

disorders of initiating and mantaining sleep 4DI;S% In!o(nia "alin' ,(,( +e/a#i

"a#a (an,la% al ini +e,-+i #en'an a#an.a la"oan -a!,! in!o(nia .an' lei* #ai

90?n.a +ela* e,!ia lei* #ai >0 +a*,n% In!o(nia !ein' +e/a#i "a#a ,!ia +,a

#i-aena-an "a#a ,!ia +,a RE; +o+al (en'ala(i "en,,nan #an +e/a#i e#,-!i "a#a

!+a#i,( 3 #an :%:

Un+,- #ia'no!i! "a!+i "el, #i"e*a+i-an -i+eia #ia'no!i! !ea'ai ei-,+$

"a!ien (e(ili-i -e!,li+an ,n+,- +i#, a+a, (e("e+a*an-an +i#, a+a, -,ali+a! +i#,

.an' ,,- 'an'',an +e/a#i (ini(al 3 -ali #ala( !e(in'', !ela(a (ini(al !a+,

,lan a#an.a "eo-,"a!i #en'an +i#a- i!a +i#, #an -e-a*6a+ian elei*an

+e*a#a" a-ia+n.a "a#a (ala( *ai #an !e"an/an' *ai !e+a -e+i#a- ",a!an +e*a#a"

-,an+i+a! a+a, -,ali+a! +i#, (en.ea-an "en#ei+aan .an' ),-," ea+ #an(e("en'a,*i ,n'!i #ala( !o!ial "e-e/aan%5

6



In#ivi#, #en'an in!o(nia (en'a+a-an #iin.a (ea!a +e'an' )e(a! -*a6a+i

a+a, #e"e!i "a# a!aa+ +i#, #an (ea!a !eola*ola* "i-iann.a (ela.an'la.an'%

;ee-a ia!an.a (en'el,* +a- ),-," +i#, an.a- (a!ala* "ia#i 'an'',an

-e!e*a+an #an a*-an -*a6a+i (en.ea-an -e(a+ian% Sein' (ee-a (en'a+a!in.a

#en'an (in,( oa+ a+a, al-o*ol% a#a 6a-+, "a'i (ee-a (en'el,* lela* i!i- #an

(en+al "a#a !ian' *ai (ee-a !e)aa -*a! (ea!a #e"e!i )e(a! +e'an' (,#a*

+e!in'',n' #an a#a "eo-,"a!i #en'an #ii !en#ii%

E%idemiologi1

Di A(ei-a Sei-a+ -,an' lei* !e"e+i'a "en#,#,-n.a (e(ili-i 'an'',an

+i#,% Di In#one!ia 'an'',an +i#, evaia!i +e'an+,n' "e-e/aan .an' #i(ili-i

"e-e/aan"e-e/aan .an' (en'a-ia+-an +e'an'',n.a !i-l,! +i#, !e"e+i "ea6a+

#o-+e !a+"a( !an'a+ e!a (eni(,l-an 'an'',an +i#, "a#a in#ivi#, +e!e,+% A#a

"eneli+ian .an' (e(,-+i-an a*6a 70? #ai "ea6a+ #i a-a+a (en'ala(i

in!o(nia% In!o(nia "a#a 6ani+a lei* +in''i 1: -ali ean#in' "a#a lela-i% Den'an

e+a(a*n.a ,!ia e+a(a* ",la an'-a -e/a#ian 'an'',an +i#,% Dai !,ve.

+e!e,+ /,'a #i!i(",l-an a*6a 6ani+a oan' .an' lei* #e6a!a #an (ee-a .an'

(e(ili-i !o!ial e-ono(i .an' en#a* lei* an.a- (en'ala(i 'an'',an +i#,%

Etiologi

8an.a- *al .an' #a"a+ (en.ea-an !e!eoan' (en'ala(i in!o(nia% 8eea"a

"en.ea #ian+aa -aena -on#i!i (e#i! .an' (en.ea-an n.ei "en'',naan a+

a+a, oa+oa+an .an' (e("en'a,*i +i#, !+e! 'eli!a* #e"e!i "e,a*an

lin'-,n'an (enon+on a+a, (e(a)a !a("ai la,+ (ala( #an an.a- la'i% Un+,-

lei* len'-a"n.a #a"a+ #ili*a+ "a#a 'a(a #ia6a* ini%

7



a(a :% 8eea"a Fa-+o .an' ;en.ea-an In!o(nia

Faktor )isiko1

Se"e+i .an' +ela* #i/ela!-an !eel,(n.a 6ani+a (e(ili-i i!i-o #,a -ali lei*

e!a (en'ala(i in!o(nia% e,a*an *o(on !aa+ !i-l,! *ai# #an (eno"a,!e

(e(ain-an "ean% Ke+i-a (eno"a,!e -ein'a+ (ala( #an *o+ la!*e! ia!an.a

(en''an'', +i#,% Fa-+o i!i-o lainn.a a#ala* "a#a ,!ia +,a 4#ia+a! >0 +a*,n *al ini

#i!ea-an -aena "e,a*an !lee" "a++en! !e"e+i .an' +ela* #i-e(,-a-an

!eel,(n.a%

Oan' .an' (en'ala(i 'an'',an -e!e*a+an (en+al !e"e+i (en'ala(i #e"e!i

anie+. 'an'',an i"ola a+a, ",n 'an'',an !+e!! "a!)a +a,(a /,'a (e,"a-an

a-+o i!i-o !e!eoan' #a"a+ (en'ala(i in!o(nia% al*al lain .an' /,'a

(enin'-a+-an a-+o i!i-o !e!eoan' (en#ei+a in!o(nia an+aa lain a"aila oan'

+e!e,+ (en'ala(i !+e!! (e(ili-i "e-e/aan .an' (en'*a,!-an oan' +e!e,+

e-e/a #i(ala( *ai a+a, ",n "e-e/aan #an a-+ivi+a! .an' (en'a*a,!-an

!e!eoan' "e"e'ian -e #aea* #en'an ona 6a-+, .an' ee#a%

Patofisiologi'

Ia(a +i#, /a'a .an' (e,"a-an "ola +in'-a* la-, a'a-n.a e*,,n'an

#en'an in+ea-!i #i #ala( !i!+i( a-+iva!i e+i),la% Con+o* a#ala* ila #ila-,-an

"ean'!an'an #aea* o(a!io e+i-,lai! a-an (en.ea-an -on#i!i /a'a@6a!"a#a

"a#a *e6an #i laoa+oi,(% Se#an'-an "e,!a-an "a#a #aea* i+, (en.ea-an

8



*e6an (en'ala(i -on#i!i -o(a (ene+a"% Den'an ini -i+a (en'e+a*,i a*6a !i!+i(

a-+ivi+a! e+i-,la e-e/an.a #ia+, ole* -on+ol #ai nukleus raphe #an locus

coeruleus% Di (ana !el!el #an nucleus raphe (en!e-e!i !eo+onin #an locus

coeruleus (en!e-e!i e"ine"*ine%

i-a nukleus raphe #i,!a- a+a, !e-e!in.a #i*a(a+ #a"a+ (eni(,l-an -on#i!i

+i#a- +i#,@e-,an'n.a /a( +i#, "a#a *e6an "e)oaan .an' (ii" #en'an -e/a#ian

in!o(nia% Se#an'-an ila locus coeruleus .an' #i,!a- a-an +e/a#i "en,,nan a+a,

*ilan'n.a +i#, RE; !e#an'-an +i#, non RE; +a- e,a*% Si!+i( li(i- .an' -i+a

-enal !ea'ai ",!a+ e(o!i a'a-n.a /,'a e*,,n'an #en'an -e6a!"a#aan@/a'a%

;,n'-in *al inila* .an' (en.ea-an (en'a"a -on#i!i an!ie+a! #an 'an'',an e(o!i

lainnn.a #a"a+ (en''an'', +i#, #an (en.ea-an in!o(nia%

eneli+ian +i#, #i laoa+oi,( #en'an ala+ EE (en,n/,--an a#an.a "ee#aan

an+aa !,-aela6an .an' no(al #en'an "en#ei+a #e"e!i #an an!ie+a!% a#a

"en#ei+a #e"e!i #i+e(,-an a#an.a Sleep Latency .an' e+a(a* a+a, #a"a+ /,'a

no(al% Se#an'-an RE; Latency /ela! (en/a#i lei* "en#e-% Ti#, Del+a .an' "a#a

oan' no(al #i+e(,-an !e/,(la* 20 30? "a#a "en#ei+a #e"e!i (en/a#i /a,*

e-,an'% al ini .an' (en.ea-an "en#ei+a #e"e!i (en'el,* +i#,n.a -,an'

",la!%

eneli+ian #ai ,n' (en,n/,--an a*6a "a#a !,-aela6an no(al .an' #iei

an'!an' !,aa!,aa "a#a !+a#i,( Del+a +i#a- +ean',n ole* *al i+,% Te+a"i "a#a

"en#ei+a #e"e!i !an'a+ (,#a* +ean',n% Kaena i+, "en#ei+a #e"e!i (,#a* !e-ali

+ean',n ole* a#an.a "e,a*an !,*, #i #ini *ai "e,a*an !ina #an !,aa!,aa

*e6an #i "a'i *ai% a#a a!e a6al "en.a-i+ "en#ei+a% #e"e!i a-an (en'ala(i

"en,,nan #ai Ti#, RE; n.a !ean.a- 10?%

RE; (en,n/,--an a*6a oan' i+, !e#an' e(i("i% Di laoa+oi,( +i#,

G5? #an (ee-a .an' #ian',n-an "a#a 6a-+, +i#, RE; (en'a-, !e#an'

e(i("i% en#ei+a #e"e!i ia!an.a (en'ala(i (i("i(i("i .an' +i#a-

(en.enan'-an !e*in''a (ee-a +ean',n -aenan.a% Den'an #e(i-ian +i#, RE;

",n e-,an' -aena !ein'n.a +ean',n #i (ala( *ai% Di !a("in' i+, +ela*

#i+ean'-an a*6a "a#a (ee-a .an' (en#ei+a #e"e!i +i#, RE; lei* )e"a+

#a+an'n.a% Se)aa i!iolo'i- -e-,an'an +i#, RE; i+, *a,! #ia.a -e(ali%

Den'an e'i+, !elan' eea"a 6a-+, "en#ei+a #e"e!i a-an (en'ala(i +i#, RE;

.an' elei*an #an "en#ei+a a-an lei* !ein' +ean',n #an e(i("i ,,-%

9



a#i /ela!la* (en'a"a #i laoa+oi,( +i#, #i+e(,-an 'a(aan *i"no'a(

.an' Hacak-acakan” a+a, ie',la #ai "e"in#a*an !a+, !+a#i,( -e !+a#i,( .an' lain

"a#a "en#ei+a #e"e!i #an !ein' +ean',n #i (ala( *ai% a#a "en#ei+a an!ie+a!

#an *i"no'a( #i+e(,-an Sleep Latency .an' (e(an/an'% Se#an'-an RE; Latency

#a"a+ no(al a+a, lei* "an/an' #ai "a#a !,-aela6an no(al% 8ee#a #en'an

"en#ei+a #e"e!i "a#a "en#ei+a an!ie+a! +i#, #el+a ia!an.a no(al 42030?

!e#an'-an +i#, RE; (en/a#i e+a(a* +e,+a(a "a#a a!e a-*i #ai +i#, 4#i #ini

*ai% a#a *i"no'a( /,'a #i+e(,-an a#an.a 'a(aan .an' ie',le #ai

"e"in#a*an !a+, !+a#i,( +i#, -e !+a#i,( +i#, .an' lain% Di a6a* ini #i'a(a-an

!,a+, !-e(a "ee#aan #ai in!o(nia -aena -on#i!i #e"e!i #an an!ie+a! #ili*a+ #ai

-el,*an !,.e-+i #an 'a(aan o.e-+i (en,,+ *i"no'a(n.a%

*anifestasi +linis

;anie!+a!i in!o(nia i!a e,"a -e!,li+an ,n+,- /a+,* +e+i#, "a#a 6a-+, .an'

no(al 4initial insomnia .ai+, -e!,li+an ,n+,- /a+,* +e+i#, a#ala* -e!,li+an +e+i#,

.an' lei* #ai 30 (eni+% 8ia!an.a #i!ea-an -aena +in'-a+ -e!a#aan .an' +in''i

.an' e*,,n'an #en'an anie+a! a+a, a-+o lain% ;anie!+a!i -lini! lainn.a .ai+,

-e!,li+an ,n+,- (e("e+a*an-an +i#,@!ein' +ea',n lal, +e+i#, -e(ali% Kea#aan

ini i!a (,n),l !e)aa ie',le #ala( 1 (ala( a+a, (,n),l "a#a 6a-+,6a-+,

+e+en+, !e"e+i !ela(a a!e +i#, RE; +ean',n lei* )e"a+ #i "a'i *ai% 4 terminal

insomnia% Kon#i!i ini ),-," !ein' #i+e(,-an "a#a oan' +,a% ;ea!a +e+a" lela*

#an (en'an+,- (e!-i",n #,a!i +i#, !,#a* ),-,"% ;ea!a )e(a! /i-a !,#a*

(en#e-a+i 6a-+, +i#,%

+lasifikasi Insomnia ,erdasarkan -aktu Terjadin&a

1. Transient Insomnia

Tean!ien+ in!o(nia a#ala* in!o(nia .an' elan'!,n' -,an' #ai 3 (in'', #an

ia!an.a e*,,n'an #en'an -e/a#ian-e/a#ian +e+en+, .an' elan'!,n' !e(en+aa

#an ia!an.a (eni(,l-an !+e!! #an #a"a+ #i-enali #en'an (,#a* ole* "a!ien

!en#ii% Dia'no!i! +an!ien+ in!o(nia ia!an.a #i,a+ !e)aa e+o!"e-+i !e+ela*

-el,*an "a!ien !,#a* *ilan'% Kel,*an ini -,an' lei* #i+e(,-an !a(a "a#a "ia #an

6ani+a #an e"i!o#e e,lan' /,'a ),-," !ein' #i+e(,-an a-+o .an' (e(i), an+aa

lain a-ia+ lin'-,n'an +i#, .an' ee#a 'an'',an ia(a !i-a#ian !e(en+aa a-ia+

/e+ la' a+a, o+a!i 6a-+, -e/a !+e!! !i+,a!ional a-ia+ lin'-,n'an -e/a a, #an

10



lainlainn.a% Tan!ien+ in!o(nia ia!an.a +i#a- (e(el,-an +ea"i -*,!,! #an /aan'

(e(a6a "a!ien -e #o-+e%

2. Short/term Insomnia

8elan'!,n' 1> ,lan #an ia!an.a #i!ea-an ole* -e/a#ian-e/a#ian !+e!!

.an' lei* "e!i!+en !e"e+i -e(a+ian !ala* !a+, an''o+a -el,a'a%

#. 0&$li$al Insomnia )e$urrent Insomnia!

Kon#i!i ini lei* /aan' #ai"a#a +an!ien+ in!o(nia% Kon#i!i ini +e/a#i a-ia+

-e+i#a-!ei(an'an an+aa +i#, #an an',n% Ke+i#a-!ei(an'an ini #a"a+ +e/a#i

!e(en+aa a+a,",n !e,(, *i#,"% Ke/a#ian e,lan' ini i!a +e/a#i a-ia+ "e,a*an

i!iolo'i! !e"e+i !i-l,! "e(en!+,al a+a,",n "e,a*an "!i-olo'i- !e"e+i (ani-

#e"e!i anoeia nevo!a a+a, -a(,*n.a "e,a*an "eila-, +e+en+, !e"e+i

-e)an#,an oa+ #an lain !ea'ain.a%

'. 0hroni$ Insomnia Persistent Insomnia!

8elan'!,n' lei* #ai > ,lan% Dia'i (en/a#i 2 .ai+, in!o(nia "i(e #an

!e-,n#e%

*a$am/*a$am Insomnia dan ubungann&a dengan Etiologi

1. Insomnia Psikofisiologik *eneta%

In!o(nia ini #ia-ia+-an ole* -aena -e+a'an'an -oni- )e(a! "e(ia!aan ne'a+i

+e*a#a" lin'-,n'an +i#, a+a, ",n -o(ina!i #ai !e(,a *al #ia+a!% e/alan.a

"a!ien a-an !ein' +ean',n (i("i .an' #iala(i a#ala* (i("i .an' (e(,a+

#iin.a )e(a! o+o+o+o+ (,#a* +e'an' #an na#i )e"a+% a!ien a-an +i#, lei* ai-

ila +i#a- e-e/a ),+i a+a, ea#a #i lin'-,n'an +i#, .an' a,% 8ia!an.a #ia'no!i!

a, #a"a+ #i+e'a-an !e+ela* (en.in'-i-an !e'ala -e(,n'-inan lain% Tea"i .an'

#a"a+ #iei-an "a#a "a!ien ini a#ala* la+i*an ela-!a!i #an +ea"i "eila-,%

2. Insomnia terkait dengan gangguan ansietas atau gangguan ke%ribadian

A#a 'a(aan EE a-an +e#a"a+ a'(en+a!i +i#, e-,an'n.a +i#,

'elo(an' la(a+ #an !e#i-i+ +i#, RE;% Sein'n.a in!o(nia !e/a/a #en'an

ea+n.a 'an'',an "!i-ia+i-% ola +i#, a-an (e(ai- !eiin' #en'an 'e/ala

"!i-ia+i-n.a% Tea"i e,"a la+i*an ela-!a!i +ea"i "eila-, #an (en'oa+i 'e/ala

"!i-ia+in.a a-an !an'a+ (e(an+, #ala( (e("eai-i 'e/ala in!o(nia%

#. Insomnia terkait dengan de%resi

11



De"e!i ea-ia+ 'eli!a* +i#, +a- ",a! !ein' +ean',n #an la+en!i RE; .an'

"en#e-% I!n!o(nia !ein' "a#a "a'i ,+a 4+e(inal in!o(nia% a!ien #e"e!i +i"e

i"ola a+a, a+i"i- ia!an.a e-e(an' (en/a#i *i"e!o(nia%

'. Insomnia terkait dengan mania

a!ien (ania +i#, a(a+ !e#i-i+ .ai+, *an.a e-i!a 2: /a( !a/a #ala( !e*ai

#en'an a+a,",n +an"a +i#, !ian' .an' ai-% Sein'-ali "a!ien a*-an +i#a- +i#,

!a(a !e-iali #an a, a-an +e+i#, /i-a (ea!a lela*% Kel,a'a .an' #a"a+ (e(a6a

"a!ien ,n+,- #i"ei-!a-an ia!an.a (en'el,-an a*6a "a!ien +i#, !an'a+ !e#i-i+%

. Insomia terkait dengan kambuhn&a ski3ofresia atau %sikosis fungsional

aa "en#ei+a !-ioenia (e(ili-i "ola +i#, .an' +i#a- /ela!% Te-a#an' (ee-a

+i#, a(a+ "an/an' a+a, +i#a- +i#, !a(a !e-ali% ;ee-a #ala( +i#,n.a !ein'

+ean',n% Kea" -ali #ala( eea"a -a!,! #i+e(,-an i+(e *aian .an' +i#a- !e!,ai

#en'an i+(e +i#, ia!a 4!i-l,! +i#, +eali-% Tea"i ,n+,- "a!ien ini a#ala* #en'an

(e(ei-an an+i"!i-o"+i-a #e(i (en',an'i 'e/ala "!i-o+i-%

. Insomnia terkait dengan a%nea

A"aila !e!eoan' (en'ala(i a"nea !ela(a 10 #e+i- -e+i-a "a!ien +e!e,+

+ean',n a-an !,li+ a'in.a ,n+,- +e+i#, -e(ali% A"nea !en#ii #ia'i (en/a#i

+i'a$ a"nea !en+alnaa! *en+i !,(a+an alian ,#aa a+a!n'oo- -ea! )a(",an

a!e "e+a(a !en+al -e(,#ian #ii-,+i na"a! ea+ a-ia+ !,(a+an !e(en+aa% Ti"e

a+a! #an )a(", #a"a+ #ioa+i #en'an +,,nn.a 88 a+a, +a-eo!+o(i%

4. Insomnia terkait dengan mioklonus nokturna

;io-lon,! no-+,na a#ala* -on+a-!i "eio#i- !aa+ +i#, "a#a "in'',l +,n'ai

(a+a -a-i a+a,",n -a-i .an' #ii-,+i !ia'a "a!ial a+a, ",n len'-a"% La(an.a

ia!an.a elan'!,n' 10 #e+i- a+a, lei*% a(aan EE +i#a- #i+e(,-an a#an.a

+an#a -e/an'% Ki+a *a,! #a"a+ (e(e#a-an -on#i!i ini #ai -e/an' #an -e/,+an

*i"ni-'ea-an o+o+ -a!a !aa+ /a+,* +i#, .an' +a- "a+olo'i-%

5. Insomnia terkait dengan al$ohol

8an.a- oan' !ein' ean''"an a*6a al-o*ol #a"a+ (e(an+, (e("e)e"a+

+i#, (e(an' ena #e(i-ian na(,n "a#a -en.a+aann.a (en'on!,(!i al-o*ol #a"a+

(en'a)a,-an RE; #an "ola +i#,% Kaena i+,la* a-an #i#a"a+i *a!il +i#, .an' +i#a-

",a! #an +i#a- !e'a% a#a oan' .an' (e,"a-an "en'',na al-o*ol -oni- +i#a-

a-an #i+e(,-an !+a#i,( 3 #an : "a#a "ola +i#,n.a% e(,+,!an al-o*ol a#ala*

lan'-a* a6al .an' ai- ,n+,- (e("eai-i in!o(nia%

6. Insomnia terkait dengan %utus alkohol

12



oa+ .an' (ene-an !,!,nan !aa ",!a+ (,lai #ai oa+ an+i anie+a! #an eea"a

oa+ an+i #e"e!% Oa+ *i"no+i- !elain "ene-anan a-+ivi+a! !,!,nan !aa ",!a+ .an'

#i"a-!a-an #ai "o!e! i!iolo'i! /,'a (e(",n.ai ee- -ele(a*an .an' #ia!a-an

ee-n.a "a#a *ai ei-,+n.a 4lon' a)+in' !e*in''a (en''an'', a-+ii+a! !e*ai*ai%

8e'i+, ",la ila "e(a-ain oa+ /an'-a "an/an' #a"a+ (eni(,l-an ove #o!i! #an

-e+e'an+,n'an oa+%

Seel,( (e("e',na-an oa+ *i"no+i- *a,! +elei* #a*,l, #i+en+,-an /eni!

'an'',an +i#, (i!aln.a a"a-a* 'an'',an "a#a a!e la+en!i "an/an' 4NRE;

'an'',an "en#e- an',n +elal, #ini )e(a! !e"an/an' *ai -,an' +i#, "a#a

(ala( *ai a#an.a "e,a*an /a#6al -e/a@-e'ia+an a+a, a-ia+ 'an'',an "en.a-i+

"i(en.a% Wala,",n oa+ *i"no+i- +i#a- #i+,n/,--an #ala( "en'',naan 'an'',an

+i#, -oni- +a"i #a"a+ #i"e',na-an *an.a ,n+,- !e(en+aa !a(il #i)ai "en.ea

.an' (en#a!ai% Den'an "e(a-aian oa+ .an' a!ional oa+ *i"no+i- *an.a ,n+,-

(en'-oe-!i #ai "ole(a 'an'',an +i#, !e#ini (,n'-in +an"a (enilai -on#i!i

"i(en.a #an *a,! e*a+i*a+i "a#a "e(a-aian oa+ *i"no+i- ,n+,- /an'-a "an/an'

-aena a-an (en.ea-an +e!el,,n'n.a -on#i!i .an' (en#a!ain.a !e+a a-an

elan/,+ +an"a "en.ele!aian .an' (e(,a!-an%

a#i .an' +e"en+in' #ala( "en'',naan oa+ *i"no+i- a#ala* (en'i#en+ii-a!i #ai

"ole( 'an'',an +i#, !e#ini (,n'-in +an"a (enilai -on#i!i "i(en.a #an*a,!

e*a+i*a+i "a#a "e(a-ain oa+ *i"no+i- ,n+,- /an'-a "an/an' -aena a-an

(en.ea-an +e!el,,n'n.a -on#i!i .an' (en#a!ain.a !e+a a-an elan/,+ +an"a

"en.ele!aian .an' (e(,a!-an% a#i .an' +e"en+in' #ala( "en'',naan oa+ *i"no+i-

a#ala* (en'i#en+ii-a!i "en.ea .an' (en#a!ain.a a+a, oa+ *i"no+i- a#ala*

!ea'ai "en'oa+an +a(a*an% e(ili*an oa+ *i"no+i- !eai-n.a #iei-an /eni! oa+

.an' eea-!i )e"a+ 4!*o+ a)+ion #'n(e(a+a!i "en'',naann.a !e"en#e- (,n'-in

.an' #a"a+ (en'e(ali-an "ola +i#, .an' no(al%

La(an.a "en'oa+an *a,! #ia+a!i 13 *ai ,n+,- +an!ien+ in!o(nia #an +i#a-

lei* #ai 2 (in'', ,n+,- !*o+ +e( in!o(nia% Un+,- lon' +e( in!o(nia #a"a+

#ila-,-an eval,a!i -e(ali ,n+,- (en)ai la+a ela-an' "en.ea 'an'',an +i#,

.an' !eenan.a% 8ila "en'',naan /an'-a "an/an' !eai-n.a oa+ +e!e,+ #i*en+i-an

!e)aa ela*anla*an ,n+,- (en'*in#a-an 6i+*#a6 +ea"i% 8eea"a oa+ .an'

#a"a+ #i',na-an a#ala*$

1.1 ,en3odia3e%in

14



;e,"a-an oa+ 'olon'an *ino+i-!e#a+i% Ee-+i #i',na-an ,n+,- (en'oa+i

(a!ala* +i#, !e"e+i e/alan #ala( +i#, #an (ala( +eo% Na(,n oa+ ini #a"a+

(en.ea-an An#a (ea!a (en'an+,- "a#a !ian' *ai #an /,'a #a"a+ (en.ea-an

-e+e'an+,n'an .an' ea+i an#a #a"a+ !elal, "el, oa+ +i#,

1.2 Antide%ressan

8eea"a an+i#e"e!an +,,+ (en'an#,n'i ee- !e#a+i .an' -,a+ !ea'i )on+o*

a(i+i"+iline #oe"in (i+aa"in #an +a#aon% Na(,n -aena (e(",n.ai /al, -e/a

.an' lea ee- !a("in'n.a (enin'-a+% In!o(nia a#ala* 'e/ala ,(,( #ai #e"e!i%

Den'an #e(i-ian eea"a oa+ an+i#e"e!an !e"e+i +ao#one 4De!.el !an'a+

ee-+i #ala( (en'oa+i -e!,li+an +i#, #an -e)e(a!an .an' #i!ea-an ole* #e"e!i%

1.# Antihistamin

An+i*i!+a(n #ien*i#a(in #i',na-an (el,a!% ;ee-a ,(,(n.a e-e/a ai-

+e+a"i #a"a+ (en.ea-an ",!in' -ee!o-an *ain.a% ;ee-a ),-," a(an ,n+,- #i/,al

+an"a e!e"% Na(,n /i-a an#a !e#an' (en'a(il oa+ lain .an' /,'a (en'an#,n'

an+i*i!+a(in -elei*an #o!i! i!a +e/a#i%

2. Psikotera%i '

Kee!i*an Ti#, H!lee" *.'ieneJ a#ala* -e'ia+an !e*ai*ai #an -eia!aan .an'

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+esim%ulan

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In!o(nia (e,"a-an !,a+, 'e/ala .an' #i+an#ai #en'an !,li+ +i#, a+a,

(e("e+a*an-an +i#,% I!+ila* lain a'i in!o(nia a#ala* Disorder of Initiating and

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#i-el,*-an #an ia!an.a !e+ela* an',n #ai +i#, !e!eoan' i+, +i#a- (ea!a !e'a%

In!o(nia #a"a+ #i!ea-an ole* an.a- *al% en'oa+an .an' ee-+i a#ala*

"en'oa+an .an' !e!,ai #en'an "en.ea +e/a#in.a in!o(nia%

(aftar Pustaka

1% To( DA% 8,-, !a-, "!-ia+i% E# >% a-a+a$ EC200:%

2% De6an+o S,6ono W Ri.an+o 8 T,ana % an#,an "a-+i! #ia'no!i! #an

+a+ala-!ana "en.a-i+ !aa% a-a+a$ EC 2009%l( 1GG92%

3% Sa+eia ; Ca!-a#on ;A% In!o(nia sleep medicine% *ila#el"*ia$ anle.

8el,! In)%2002%al 1539%

:% Ka"lan I Sa#o)- 8% 8,-, !a-, "!i-ia+i -lini-% a-a+a$ 8ina,"a A-!aa2007% *l( 13G 31G :02:%

5% Ka"lan I Sa#o)- 8% In!o(nia% Il(, -e#o-+ean /i6a #a,a+% a-a+a$ Wi#.a

;e#i-a2007% *l( 31520%

>% a"aie! Wilie% an'',an +i#,% 8,-, !a-, "i-ia+i -lini-% a-a+a$ 8ina,"a

A-!aa 2007% *l( 1G9192

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