Insomnia失眠讲座

1、Cognitive-Behavioral Treatment of InsomniaMartita Lopez, Ph.D.Department of PsychologyUniversity of Texas at AustinSleep stagesnWe cycle through the stages of sleep about every 90 minutes during the night, in the same ordernMost dreaming occurs during the second half of the night, as REM sleep lasts

2、 longer and longernStage 1: Very light sleepnStage 2: Light sleepnStage 3: Deeper sleepnStage 4: Very deep sleep, most restorativenStage 5: REM sleep, when we dreamSleep throughout lifenChildhood and adolescencenSleep needs range from 18 hrs a day for infants to about 9 hrs a day for teenagersnAdult

3、hoodnAmount of deep sleep drops dramatically between age 20 and 40, and average sleep time is 7.5 hoursnWomens reproductive cycles affect sleepnEspecially pregnancy (sleepier first trimester)nAlso affected by menstrual cycle (sleepier second half of cycle)Sleep in middle agenSleep becomes lighter an

4、d nighttime awakenings become more frequent and last longernOften wake up after 3 hours of sleepnMenopause may lead to hot flashes that interrupt sleep repeatedlynBreathing problems may begin, especially among overweight peoplenPhysically active adults sleep more soundly than their sedentary peers.n

5、About 20% of sleep time is spent in dreamingSleep among older adultsnLittle deep sleep, but dreaming still 20%nDozens of awakenings during the nightnFalling asleep takes longernDespite the above, over a 24-hour period older adults accumulate the same amount of total sleep as younger peoplenOlder adu

6、lts more likely to nap during the daynOlder adults do need the same amount of sleep as they did when they were youngerInsomnia: A common sleep problemnPeople with insomnia may have nTrouble falling asleepnMany awakenings during the night, with difficulty going back to sleepnFitful sleepnDaytime drow

7、sinessnDuring the day, people with insomnia may benAnxious and irritable nForgetful, with difficulty concentratingTypes of InsomnianTransient: Less than 2 weeksnIntermittent: Repetitive episodes of transient insomnianChronic: Continuing difficulty with sleepChronic insomnianComplaint of poor sleep c

8、ausing distress or impairment for 6 months or longernAverage less than 6.5 hours sleep per daynOr 3 episodes per week of:nTaking longer than 30 minutes to fall asleepnWaking up during the night for at least an hournNot accounted for by another sleep disorder, mental disorder, medical condition or su

9、bstance use.How common is insomnia?nMore than half of adults in the U.S. said they experienced insomnia at least a few nights a week during the past yearnNearly one-third said they had insomnia nearly every nightnIncreases with agenThe most frequent health complaint after painnTwice as common in wom

10、en as in menConditions that can cause insomnianHyperthyroidismnArthritis or any other painful conditionnChronic lung or kidney diseasenCardiovascular disease (heart failure, CAD)nHeartburn (GERD)nNeurological disorders (epilepsy, Alzheimers, headaches, stroke, tumors, Parkinsons Disease)nDiabetesnMe

11、nopauseCommon drugs that can cause insomnianAlcoholnCaffeine/chocolatenNicotine/nicotine patchnBeta blockersnCalcium channel blockersnBronchodilatorsnCorticosteroidsnDecongestantsnAntidepressantsnThyroid hormonesnAnticonvulsantsnHigh blood pressure medicationsAdditional CausesnPsychiatric disordersn

12、Especially phobias and panic attacks, bipolar disorder, depression, and schizophrenianPoor sleep habitsnShift worknOther sleep disordersnCircadian rhythm disordersnRestless legs syndromenPeriodic limb movement disordernSleep apneaConsequences of insomnianDecreases in mental performance and motor fun

13、ctioningnAccidentsnInability to accomplish daily tasksnMood disturbancenMore sadness, depression, and anxietynInterpersonal difficultiesnWith families, friends, and at workSleeping pillsnMost common treatment approachnDrowsiness common the next daynNOT meant for chronic insomnianEffective for short-

14、term (a couple weeks) insomnia onlynTolerance and dependency may developnWithdrawal, rebound, relapse may occurnBut commonly used, despite the aboven5-10% of adults have used a benzodiazepine in past year as a sleep aidn10-20% of those over age 65 use sleeping pills Non-drug treatmentsnCognitive-beh

15、avioral therapy (CBT)nStimulus controlnCognitive therapynSleep restrictionnRelaxation trainingnSleep hygieneHow to keep track of your sleepnDaily sleep diary or sleep lognBedtimenFalling asleep timenNighttime awakeningsnTime to get back to sleepnWaking up timenGetting out of bed timenNapsCognitive T

16、herapynIdentify beliefs about sleep that are incorrectnChallenge their truthfulnessnSubstitute realistic thoughtsFalse beliefs about insomnianMisconceptions about causes of insomnian“Insomnia is a normal part of aging.”nUnrealistic expectations re: sleep needsn“I must have 8 hours of sleep each nigh

17、t.”nFaulty beliefs about insomnia consequencesn“Insomnia can make me sick or cause a mental breakdown.”nMisattributions of daytime impairmentsn“Ive had a bad day because of my insomnia.” nI cant have a normal day after a sleepless night.” More common myths about insomnianMisconceptions about control

18、 and predictability of sleepn“I cant predict when Ill sleep well or badly.”nMyths about what behaviors lead to good sleepn“When I have trouble getting to sleep, I should stay in bed and try harder.”Sleep Restriction - best if done with a professionalnCut bedtime to the actual amount of time you spen

19、d asleep (not in bed), but no less than 4 hours per nightnNo additional sleep is allowed outside these hoursnRecord on your daily sleep log the actual amount of sleep obtainedSleep Restriction (contd)nCompute sleep efficiency (total time asleep divided by total time in bed)nBased on average of 5 nig

20、hts sleep efficiency, increase sleep time by 15 minutes if efficiency is 85%nWith elderly, increase sleep time if efficiency 80% and allow 30 minute nap.Stimulus Control - You can do this on your ownnGo to bed only when sleepynUse the bed only for sleepingnIf unable to sleep, move to another roomnRe

21、turn to bed only when sleepynRepeat the above as often as necessarynGet up at the same time every morningnDo not napRelaxation trainingnMore effective than no treatment, but not as effective as sleep restrictionnMore useful with younger compared with older adultsnEngage in any activities that you fi

22、nd relaxing shortly before bed or while in bednCan include listening to a relaxation tape, soothing music, muscle relaxation exercises, a pleasant imageHealthy sleep habits (sleep hygiene)nAvoid alcohol, nicotine, caffeine, chocolatenFor several hours before bedtimenCut down on non-sleeping time in

23、bednBed only for sleep and satisfying sexnAvoid trying to sleepnYou cant make yourself sleep, but you can set the stage for sleep to occur naturallynAvoid a visible bedroom clock with a lighted dialnDont let yourself repeatedly check the time!nCan turn the clock around or put it under the bedMore healthy sleep habitsnExpose yourself to bright light at the right timenM