主诉失眠的门诊就诊者主客观评估的睡眠质量与生命质量

目的:失眠者的主观睡眠感与实际睡眠情况常有不一致的现象,本研究通过探讨以失眠为主诉的门诊就诊者睡眠质量的主观、客观评估指标与生命质量的相关性,为临床制定失眠的整体治疗方案提供参考依据。方法:连续收集64例以失眠为主诉的接受多导睡眠图(PSG)检查的门诊患者的资料,用匹兹堡睡眠质量指数(PSQI)评估主观睡眠质量,SF-36健康调查量表评估生命质量,用贝克抑郁问卷(BDI)、贝克焦虑问卷(BAI)评估情绪状态。以17例正常人的PSG数据作为客观睡眠质量的基础对照。结果:本组失眠就诊者90%主观评价睡眠质量差,其PSG指标中与正常对照相比睡眠潜伏期延长、清醒次数增加、睡眠效率降低、快动眼睡眠潜伏期延长(均P<0.05)。失眠就诊者PSQI总分与SF-36生理健康总分呈负相关(r=-0.25,P<0.05),但以BDI、BAI分作为控制变量进行偏相关分析显示,PSQI总分及各因子分与SF-36生理健康和心理健康总分相关性无统计学意义;PSG主要指标与SF-36生理健康和心理健康总分相关性无统计学意义。结论:本研究显示失眠者主观感受的睡眠质量更可能与生命质量相关,但与失眠相关的抑郁、焦虑情绪可能起到主要作用,这提示失眠治疗中应重视改善患者的主观睡眠质量,以及识别和处理情绪问题。     

睡眠与饮食

睡眠不仅是一种基本的生理需求，更是心理需要。对于现代人来说，能睡个好觉真该算是种幸福，因为失眠的人太多了。中华医学会睡眠中心前不久发布了一项调查结果，在北京、上海等六大城市的10000名受访者中，有一半人都存在不同程度的失眠。而近日在雀巢公司对九个城市150名记者的调查结果也显示，40名的记者有过失眠问题，87％的人认为睡眠问题已给工作和生活带来了负面影响。     

慢性失眠者多道睡眠图的观察及定量分析

目的：探讨慢性失眠者的多道睡眠图观察及定量分析对评价睡眠效率的意义。方法：慢性失眠者71例,正常对照组40例,分别进行了睡眠问卷及多道睡眠图检查,结果：主观性失眠与客观性失眠的多道睡眠图观察及定量分析,结果发现失眠患者觉醒后估计与多道睡眠图所记录的一些睡眠参数存在差异。结论：根据多道睡眠图观察及定量分析可区分出主观性失眠与客观性失眠,可以客观测量睡眠效率,睡眠效率是评价失眠严重程度的重要指标,睡眠周期只做参考。     

调节心身助睡眠

生活中，睡眠差常常被当成是小毛病，可一旦失眠，人们就会苦不堪言。大部分人把失眠仅当做生理性疾病，接受内科、针灸、理疗、中医等多种治疗方法，而不愿去看心理门诊，然而因心理问题引起的失眠占70％以上。     

改善睡眠并不难

科学习惯保证睡眠,良好环境适宜睡眠,心理调节克服失眠,合理饮食促进睡眠,适当运动加速睡眠。     

短期心理干预联合药物治疗地震后失眠患者的疗效观察

目的观察短期心理干预联合药物治疗地震后失眠患者的疗效。方法将120例汶川地震后首次出现失眠症状的患者随机分配至研究组和对照组,各60例,分别给予为期2周的心理干预联合药物治疗或单纯药物治疗,并用汉密顿抑郁量表（HAMD）的睡眠因子及每晚总睡眠时间来评定疗效。结果研究组的睡眠因子在治疗第1周末即有显著下降,在第2周末明显低于对照组;两组在治疗第2周末总睡眠时间均有显著增加,但研究组明显多于对照组。结论短期心理干预联合药物治疗地震后失眠患者的疗效优于单纯药物治疗。     

国内外小儿睡眠障碍研究资料综合分析

睡眠是人体的生理需要。小儿睡眠障碍会影响神经心理和认知发育，造成情绪、行为和注意力等方面的问题。分析①国内小儿睡眠障碍14505例资料显示有睡眠障碍4647人，小儿睡眠障碍总体发病率为32．0％。男性睡眠障碍发病率为40．5％．女性睡眠障碍发病率为36．2％，无统计学差异；②国外小儿睡眠障碍发病率前4位依次是梦呓、磨牙、梦魇、夜醒、失眠；国内小儿睡眠障碍发病率前5位依次是夜醒、梦魇、晚睡和难觉醒；③睡眠障碍对小儿白天神经心理和认知有明显影响，主要表现为注意缺陷、多动、创造能力下降、记忆力下降、行为障碍和情绪问题。结论 小儿睡眠障碍发病率较高。小儿睡眠障碍会防碍小儿神经心理和认知能力的健康发展。     

慢性失眠症患者的应对方式和睡眠行为特征对照研究

目的 :调查慢性失眠症患者的睡眠行为特征、应对方式和心理控制源 ,以及三者之间的关系。方法 :62名慢性失眠症男女患者和配对睡眠正常者完成睡眠行为特征量表 (包括有无对睡眠的不合理信念、非功能性睡眠行为和夜间情绪焦虑三个分量表 )、应对方式和I—E心理控制源量表评估。结果 :慢性失眠症组与睡眠正常组比较有更多的对睡眠的不合理信念、非功能性睡眠行为 (t =8 96,P <0 0 1)和夜间情绪焦虑 (t =3 7 61,P <0 0 1) ,应对方式在解决问题因子分 (t =6 3 6,P <0 0 1)和自责因子分 (t =4 17,P <0 0 5 )分别低于和高于睡眠正常组 ,I—E心理控制源量表分高于睡眠正常组 (t =4 5 ,P <0 0 5 )。逐步多元回归分析显示失眠患者的不合理信念和非功能性睡眠行为与解决问题、心理控制源有相关性 (P均 <0 0 1)。结论 :慢性失眠症患者存在对睡眠的不合理信念、非功能性睡眠行为和夜间情绪焦虑。应对方式和心理控制源与睡眠正常者比较主要表现在解决问题能力低 ,心理控制源外控。解决问题方式和心理控制源外控可能对患者的不合理信念和非功能性睡眠行为的形成构成影响。     

原发性失眠患者生活质量及影响因素

目的:探讨原发性失眠患者生活质量及影响因素。方法:对病例组85例和对照组57例进行生活质量综合评定问卷(GQOLI-74)评估比较,对可能影响生活质量的因素进行回归分析。结果:(1)GQOLI-74 总体评估中病例组的生活质量总分、躯体功能、心理功能、社会功能比对照组分别低33分、17分、10分、4分(均分分别为254.9±26.4/287.1±30.4,t=-5.15,P<0.01;60.3±8.9/77.7±7.2,t=-9.71,P<0.01;65.5±7.3/75.0±11.0.t=-4.98,P<0.01;64.9±8.7/68.8±9.4,t=-2.31,P<0.05);(2)已婚、年龄越大、睡眠脑电图参数中的总睡眠时间和慢波睡眠时间越长,原发性失眠患者生活质量评估越高;PSQI 评分越高及睡眠潜伏期越长、夜间觉醒次数越多,生活质量评估越低。结论:原发性失眠患者的生活质量在躯体、心理和社会维度有显著降低,部分人口学特征和失眠的主客观严重程度是影响生活质量评估的主要因素。     

智能心理多功能减压训练对潜艇艇员睡眠质量的影响

目的探讨智能心理多功能减压训练对潜艇艇员睡眠情况的影响。方法采用匹兹堡睡眠质量指数问卷(PSQI)对潜艇艇员进行评估,将PSQI7分的12名艇员作为训练组,12名PSQI7分的艇员作为对照组,对训练组的艇员进行智能心理多功能减压训练。结果训练前训练组在睡眠质量、入睡时间、睡眠时间、睡眠障碍、日间功能障碍的得分显著高于对照组(t=4.73,5.93,2.80,2.80,5.00;P0.01);训练后训练组在睡眠质量、入睡时间、睡眠时间、睡眠障碍、日间功能障碍上的得分显著低于训练前(t=9.57,7.29,7.42,4.63,6.51;P0.01),在睡眠效率、催眠药物上的得分低于训练前,但差异无统计学意义(P0.05)。训练组训练后脉搏、呼吸、PNN50的得分显著低于训练前(t=3.96,3.63,5.52;P0.01),H放松指数为(76.48±44.33),B放松指数为(89.31±24.58),综合放松度为(89.56±30.24)。结论智能心理多功能减压训练对治疗缓解失眠、引导睡眠有明显作用。     

Practice parameters for the evaluation of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine

Chronic insomnia is the most common sleep complaint which health care practitioners must confront. Most insomnia patients are not, however, seen by sleep physicians but rather by a variety of primary care physicians. There is little agreement concerning methods for effective assessment and subsequent differential diagnosis of this pervasive problem. The most common basis for diagnosis and subsequent treatment has been the practitioner's clinical impression from an unstructured interview. No systematic, evidence-based guidelines for diagnosis exist for chronic insomnia. This practice parameter paper presents recommendations for the evaluation of chronic insomnia based on the evidence in the accompanying review paper. We recommend use of these parameters by the sleep community, but even more importantly, hope the large number of primary care physicians providing this care can benefit from their use. Conclusions reached in these practice parameters include the following recommendations for the evaluation of chronic insomnia. Since the complaint of insomnia is so widespread and since patients may overlook the impact of poor sleep quality on daily functioning, the health care practitioner should screen for a history of sleep difficulty. This evaluation should include a sleep history focused on common sleep disorders to identify primary and secondary insomnias. Polysomnography, and the Multiple Sleep Latency Test (MSLT) should not be routinely used to screen or diagnose patients with insomnia complaints. However, the complaint of insomnia does not preclude the appropriate use of these tests for diagnosis of specific sleep disorders such as obstructive sleep apnea, periodic limb movement disorder, and narcolepsy that may be present in patients with insomnia. There is insufficient evidence to suggest whether portable sleep studies, actigraphy, or other alternative assessment measures including static charge beds are effective in the evaluation of insomnia complaints. Instruments such as sleep logs, self-administered questionnaires, symptom checklist, or psychological screening tests may be of benefit to discriminate insomnia patients from normals, but these instruments have not been shown to differentiate subtypes of insomnia complaints.     

Validity,potential clinical utility and comparison of a consumer activity tracker and a research‐grade activity tracker in insomnia disorder II: Outside the laboratory

Accurate assessment of sleep can be fundamental for monitoring, managing and evaluating treatment outcomes within diseases. A proliferation of consumer activity trackers gives easy access to objective sleep. We evaluated the performance of a commercial device (Fitbit Alta HR) relative to a research‐grade actigraph (Actiwatch Spectrum Pro) in measuring sleep before and after a cognitive behavioural intervention in insomnia disorder. Twenty‐five individuals with DSM‐5 insomnia disorder (M = 50.6 ± 15.9 years) wore Fitbit and Actiwatch and completed a sleep diary during an in‐laboratory polysomnogram, and for 1 week preceding and following seven weekly sessions of cognitive‐behavioural intervention for insomnia. Device performance was compared for sleep outcomes (total sleep time, sleep latency, sleep efficiency and wake after sleep onset). The analyses assessed (a) agreement between devices across days and pre‐ to post‐treatment, and (b) whether pre‐ to post‐treatment changes in sleep assessed by devices correlated with clinical measures of change. Devices generally did not significantly differ from each other on sleep variable estimates, either night to night, in response to sleep manipulation (pre‐ to post‐treatment) or in response to changes in environment (in the laboratory versus at home). Change in sleep measures across time from each device showed some correlation with common clinical measures of change in insomnia, but not insomnia diagnosis as a categorical variable. Overall, the Fitbit provides similar estimates of sleep outside the laboratory to a research grade actigraph. Despite the similarity between Fitbit and Actiwatch performance, the use of consumer technology is still in its infancy and caution should be taken in its interpretation.     

Familial incidence of insomnia

This study evaluated the familial incidence of sleep disturbances among individuals with insomnia complaints. The sample consisted of 285 patients evaluated for insomnia at a sleep disorders clinic. All patients completed a sleep survey and underwent a semistructured clinical interview as part of their initial evaluation of insomnia. Information on the presence and nature of sleep disturbances among their family members (first- and second-degree relatives) was obtained from a sleep survey. The findings indicate that 35% of patients consulting for insomnia had a positive family history of sleep disturbances. Insomnia was the most common type of sleep disturbance identified (76%) and the mother was the most frequently afflicted family member. Reports of sleep disturbances among a family member were more prevalent when the onset of insomnia was before 40-years-old than when it was later in life. A positive family history was slightly higher when the insomnia complaint involved sleep-onset difficulties relative to sleep-maintenance or mixed insomnias. Although the present findings suggest that a positive family history of insomnia may be a potential risk factor for insomnia, it is unclear whether this reflects a genetic predisposition or a social learning phenomenon.     

Evaluation of chronic insomnia. An American Academy of Sleep Medicine review

Insomnia is a condition which affects millions of individuals, giving rise to emotional distress, daytime fatigue, and loss of productivity. Despite its prevalence, it has received scant clinical attention. An adequate evaluation of persistent insomnia requires detailed historical information as well as medical, psychological and psychiatric assessment. Use of a classification system for sleep disorders and familiarity with major diagnostic groups will facilitate the clinician's evaluation and treatment. Thorough assessment also requires attention to the unique aspects of presentation and specific set of etiologies which are associated with particular age groups.     

Treatment of chronic insomnia by restriction of time in bed

A treatment of chronic insomnia is described that is based on the recognition that excessive time spent in bed is one of the important factors that perpetuates insomnia. Thirty-five patients, with a mean age of 46 years and a mean history of insomnia of 15.4 years, were treated initially by marked restriction of time available for sleep, followed by an extension of time in bed contingent upon improved sleep efficiency. At the end of the 8-week treatment program, patients reported an increase in total sleep time (p less than 0.05) as well as improvement in sleep latency, total wake time, sleep efficiency, and subjective assessment of their insomnia (all p less than 0.0001). Improvement remained significant for all sleep parameters at a mean of 36 weeks after treatment in 23 subjects participating in a follow-up assessment. Although compliance with the restricted schedule is difficult for some patients, sleep restriction therapy is an effective treatment for common forms of chronic insomnia.     

Optimizing sleep in older adults: Treating insomnia

As the world's population ages, the elevated prevalence of insomnia in older adults is a growing concern. Insomnia is characterized by difficulty falling or remaining asleep, or by non-restorative sleep, and resultant daytime dysfunction. In addition to being at elevated risk for primary insomnia, older adults are at greater risk for comorbid insomnia, which results from, or occurs in conjunction with another medical or psychiatric condition. In this review, we discuss normal changes in sleep that accompany aging, circadian rhythm changes and other factors that can contribute to late-life insomnia, useful tools for the assessment of insomnia and related problems in older people, and both non-pharmacological and pharmacological strategies for the management of insomnia and optimization of sleep in later life.     

Combining cardiac monitoring with actigraphy aids nocturnal arousal detection during ambulatory sleep assessment in insomnia

Study ObjectivesThe objective assessment of insomnia has remained difficult. Multisensory devices collecting heart rate (HR) and motion are regarded as the future of ambulatory sleep monitoring. Unfortunately, reports on altered average HR or heart rate variability (HRV) during sleep in insomnia are equivocal. Here, we evaluated whether the objective quantification of insomnia improves by assessing state-related changes in cardiac measures.MethodsWe recorded electrocardiography, posture, and actigraphy in 33 people without sleep complaints and 158 patients with mild to severe insomnia over 4 d in their home environment. At the microscale, we investigated whether HR changed with proximity to gross (body) and small (wrist) movements at nighttime. At the macroscale, we calculated day-night differences in HR and HRV measures. For both timescales, we tested whether outcome measures were related to insomnia diagnosis and severity.ResultsAt the microscale, an increase in HR was often detectable already 60 s prior to as well as following a nocturnal chest, but not wrist, movement. This increase was slightly steeper in insomnia and was associated with insomnia severity, but future EEG recordings are necessary to elucidate whether these changes occur prior to or simultaneously with PSG-indicators of wakefulness. At the macroscale, we found an attenuated cardiac response to sleep in insomnia: patients consistently showed smaller day-night differences in HR and HRV.ConclusionsIncorporating state-related changes in cardiac features in the ambulatory monitoring of sleep might provide a more sensitive biomarker of insomnia than the use of cardiac activity averages or actigraphy alone.     

Cognitive-behavioral treatment of insomnia secondary to chronic pain

Sixty participants with insomnia secondary to chronic pain were assigned randomly to either a cognitive-behavioral therapy (CBT) or a self-monitoring/waiting-list control condition. The therapy consisted of a multicomponent 7-week group intervention aimed at promoting good sleep habits, teaching relaxation skills, and changing negative thoughts about sleep. Treated participants were significantly more improved than control participants on self-report measures of sleep onset latency, wake time after sleep onset, sleep efficiency, and sleep quality, and they showed less motor activity in ambulatory recordings of nocturnal movement. At a 3-month follow-up assessment, treated participants showed good maintenance of most therapeutic gains. These results provide the 1st evidence from a randomized controlled trial that CBT is an effective treatment for insomnia that is secondary to chronically painful medical conditions.     

Prevalence of reported insomnia and its consequences in a survey of 5,044 adolescents in Kuwait

STUDY OBJECTIVES: To examine the psychometric characteristics of a short scale to assess insomnia complaints and their consequences, to estimate the prevalence rates of reported insomnia, and to explore the sex differences in reported insomnia. METHODS: 5,044 male and female nonclinical secondary-school students in the State of Kuwait participated. Their ages ranged from 14 to 19 years. An insomnia scale (IS) comprising 12 items was administered in group sessions. It has acceptable test-retest and alpha reliabilities and good convergent validity. Two factors were disclosed: consequence of insomnia and difficulty in initiating and maintaining sleep. Point prevalence rate was computed as the summation of the percentages of responses in the two options: "Much" and "Very much" on each item during the most recent month. RESULTS: The prevalence of the 12 IS items ranged from 6.4% to 31.7% in boys, and between 6.5% and 35.9% among girls. The highest reported insomnia complaint was early morning awakening, ie, 31.7% in boys, and 35.9% in girls. It was found that 14.6% of boys and 20.3% of girls reported difficulty initiating sleep, while 8.6% of boys and 15.7% of girls reported difficulty maintaining sleep. Girls had higher mean scores in most of the IS items. CONCLUSIONS: Adolescents in the present sample have reported high rates of insomnia. There is a great need to agree upon the methodology, especially the assessment tool, for epidemiology of sleep disorder research.