Insomnia失眠讲座课件

Cognitive-BehavioralTreatmentofInsomniaMartitaLopez,Ph.D.DepartmentofPsychologyUniversityofTexasatAustinSleepstagesWecyclethroughthestagesofsleepaboutevery90minutesduringthenight,inthesameorderMostdreamingoccursduringthesecondhalfofthenight,asREMsleeplastslongerandlongerStage1:VerylightsleepStage2:LightsleepStage3:DeepersleepStage4:Verydeepsleep,mostrestorativeStage5:REMsleep,whenwedreamSleepthroughoutlifeChildhoodandadolescenceSleepneedsrangefrom18hrsadayforinfantstoabout9hrsadayforteenagersAdulthoodAmountofdeepsleepdropsdramaticallybetweenage20and40,andaveragesleeptimeis7.5hoursWomen’sreproductivecyclesaffectsleepEspeciallypregnancy(sleepierfirsttrimester)Alsoaffectedbymenstrualcycle(sleepiersecondhalfofcycle)SleepamongolderadultsLittledeepsleep,butdreamingstill20%DozensofawakeningsduringthenightFallingasleeptakeslongerDespitetheabove,overa24-hourperiodolderadultsaccumulatethesameamountoftotalsleepasyoungerpeopleOlderadultsmorelikelytonapduringthedayOlderadultsdo

needthesameamountofsleepastheydidwhentheywereyoungerInsomnia:

AcommonsleepproblemPeoplewithinsomniamayhaveTroublefallingasleepManyawakeningsduringthenight,withdifficultygoingbacktosleepFitfulsleepDaytimedrowsinessDuringtheday,peoplewithinsomniamaybeAnxiousandirritableForgetful,withdifficultyconcentratingTypesofInsomniaTransient:Lessthan2weeksIntermittent:RepetitiveepisodesoftransientinsomniaChronic:ContinuingdifficultywithsleepChronicinsomniaComplaintofpoorsleepcausingdistressorimpairmentfor6monthsorlongerAveragelessthan6.5hourssleepperdayOr3episodesperweekof:Takinglongerthan30minutestofallasleepWakingupduringthenightforatleastanhourNotaccountedforbyanothersleepdisorder,mentaldisorder,medicalconditionorsubstanceuse.ConditionsthatcancauseinsomniaHyperthyroidismArthritisoranyotherpainfulconditionChroniclungorkidneydiseaseCardiovasculardisease(heartfailure,CAD)Heartburn(GERD)Neurologicaldisorders(epilepsy,Alzheimer’s,headaches,stroke,tumors,Parkinson’sDisease)DiabetesMenopauseAdditionalCausesPsychiatricdisordersEspeciallyphobiasandpanicattacks,bipolardisorder,depression,andschizophreniaPoorsleephabitsShiftworkOthersleepdisordersCircadianrhythmdisordersRestlesslegssyndromePeriodiclimbmovementdisorderSleepapneaSleepingpillsMostcommontreatmentapproachDrowsinesscommonthenextdayNOTmeantforchronicinsomniaEffectiveforshort-term(acoupleweeks)insomniaonlyToleranceanddependencymaydevelopWithdrawal,rebound,relapsemayoccurButcommonlyused,despitetheabove5-10%ofadultshaveusedabenzodiazepineinpastyearasasleepaid10-20%ofthoseoverage65usesleepingpillsNon-drugtreatmentsCognitive-behavioraltherapy(CBT)StimuluscontrolCognitivetherapySleeprestrictionRelaxationtrainingSleephygieneHowtokeeptrackofyoursleepDailysleepdiaryorsleeplogBedtimeFallingasleeptimeNighttimeawakeningsTimetogetbacktosleepWakinguptimeGettingoutofbedtimeNapsCognitiveTherapyIdentifybeliefsaboutsleepthatareincorrectChallengetheirtruthfulnessSubstituterealisticthoughtsFalsebeliefsaboutinsomniaMisconceptionsaboutcausesofinsomnia“Insomniaisanormalpartofaging.”Unrealisticexpectationsre:sleepneeds“Imusthave8hoursofsleepeachnight.”Faultybeliefsaboutinsomniaconsequences“Insomniacanmakemesickorcauseamentalbreakdown.”Misattributionsofdaytimeimpairments“I’vehadabaddaybecauseofmyinsomnia.”Ican’thaveanormaldayafterasleeplessnight.”SleepRestriction-bestifdonewithaprofessionalCutbedtimetotheactualamountoftimeyouspendasleep(notinbed),butnolessthan4hourspernightNoadditionalsleepisallowedoutsidethesehoursRecordonyourdailysleeplogtheactualamountofsleepobtainedSleepRestriction(cont’d)Computesleepefficiency(totaltimeasleepdividedbytotaltimeinbed)Basedonaverageof5nights’sleepefficiency,increasesleeptimeby15minutesifefficiencyis>85%Withelderly,increasesleeptimeifefficiency>80%andallow30minutenap.RelaxationtrainingMoreeffectivethannotreatment,butnotaseffectiveassleeprestrictionMoreusefulwithyoungercomparedwitholderadultsEngageinanyactivitiesthatyoufindrelaxingshortlybeforebedorwhileinbedCanincludelisteningtoarelaxationtape,soothingmusic,musclerelaxationexercises,apleasantimageHealthysleephabits

(sleephygiene)Avoidalcohol,nicotine,caffeine,chocolateForseveralhoursbeforebedtimeCutdownonnon-sleepingtimeinbedBedonlyforsleepandsatisfyingsexAvoidtryingtosleepYoucan’tmakeyourselfsleep,butyoucansetthestageforsleeptooccurnaturallyAvoidavisiblebedroomclockwithalighteddialDon’tletyourselfrepeatedlycheckthetime!Canturntheclockaroundorputitunderthebed

MorehealthysleephabitsAdjustthebedroomenvironmentSleepisbetterinacoolroom,around65F.DarkerisbetterI