慢性失眠原因的3P模式分析和认知行为疗法治疗策略

A 3P model-based analysis of causes of chronic insomnia and therapeutic strategies of cognitive behavioral therapy

睡眠是一个自我平衡调节的生理过程,这个自我平衡的特性已经纳入睡眠调控的双历程模式,即睡眠的稳态调节和昼夜节律调节。如果睡眠的稳态调节和昼夜节律调节功能失调,或者清醒系统功能过强,都可能导致失眠。失眠具有慢性化倾向,3P模型认为,个体的易感性和先天倾向遇到诱发因素,会导致急性失眠。而负性想法和非适应性的应对行为将产生条件性唤醒,多次重复后即习得并维持至慢性失眠。目前对慢性失眠缺乏行之有效的治疗方法。失眠的认知行为疗法(CBT-I)是一类作用与睡眠药物相当、没有副作用、复发次数更少,并且远期效果优于睡眠药物的非药物治疗方法,该疗法包括渐进性放松、生物反馈、认知方法、刺激控制、时间疗法和睡眠限制疗法等,但目前在临床上未被充分利用,建议将CBT-I作为慢性失眠的一线治疗方法。

Sleep is a physiological process of homeostasis,which has been incorporated into the dual process mode of sleep regulation,namely sleep homeostasis and circadian rhythm regulation.If there is a functional disorder of the above two types of regulation or the wake-up system is overfunctioning,insomnia may occur.Insomnia has a tendency of becoming chronic.According to the 3P model,acute insomnia occurs when individual susceptibility and innate tendency are challenged by predisposing factors.While negative thoughts and non-adaptive coping behaviors will produce conditional arousal,which is learned and maintained to form chronic insomnia after repetitions.There is a lack of effective treatments for chronic insomnia.The cognitive behavioral therapy for insomnia(CBT-I)is a non-drug therapy which has an effect equivalent to hypnotics without side effects,and it produces less frequent recurrence and a long-term effect superior to hypnotics.This treatment includes progressive relaxation,biofeedback,cognitive methods,stimulus control,time therapy,and sleep restriction therapy.However,this treatment has not been fully utilized in clinical practice.CBT-I is recommended to be used as a first-line treatment.