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

摘要:

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。

Abstract:

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.