TREATMENTS FOR INSOMNIA

失眠的治疗

• 批准号: 3384783
• 负责人: JEROME A YESAVAGE
• 金额: $ 15.58万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1990
• 资助国家: 美国
• 起止时间: 1990-04-01 至 1993-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3384783
• 关键词: anxiety; behavior modification; depression; human old age (65+); human subject; human therapy evaluation; human very old age (85+); sleep deprivation; sleep disorders; wakefulness

A large proportion of the geriatric population suffers from insomnia. Hypnotic medication, though offering short-term relief, loses its efficacy in a matter of weeks. In addition, particularly for the aged, hypnotic medication may lead to carry-over effects. anterograde amnesia and exacerbation of sleep apnea. Effective non-pharmacological treatments for insomnia are sorely needed for this age group. Most existing research on psychological treatments for insomnia has focused on younger individuals. Use of such techniques in older subjects may require novel approaches and modifications of existing techniques. Changes should reflect the primacy of sleep maintenance (opposed to sleep latency) problems in elders and increased frequency of daytime sleepiness in this group. We propose to study a treatment recently reported to be successful in younger insomniacs, Sleep Restriction Therapy (SRT). SRT improves sleep quality by restricting excessive time in bed and allowing a modest accrual of sleep debt, resulting in consolidated sleep. On the basis of our initial success and experience with SRT in the aged, we will also employ a Modified SRT (MSRT) as a second treatment. In the MSRT condition subjects will be encouraged to take a single nap, carefully scheduled to occur in a fixed time relationship to their bedtimes. Both SRT and MSRT conditions will be compared to a third condition (Hygiene). Our goal is to evaluate treatments for geriatric insomnia not only in terms of improvement of sleep but also in terms of daytime function and performance. We plan to test two hypotheses: 1. Efficacy Hypothesis: SRT and MSRT will improve the sleep of community residing elderly by increasing sleep efficiency (SE) and total sleep time (TST). and by reducing latency to sleep onset (SO), the number of awakenings, and wakefulness after sleep onset (WASO), when compared with subjects in the Hygiene condition. 2. Side-Effects Hypothesis: Subjective daytime sleepiness will increase for subjects in the SRT condition but not for subjects in the MSRT condition; performance on attentional measures will improve in the MSRT condition but will remain the same or decline in the SRT condition. Hypothesis 1 (Efficacy) will be tested in a comparative group study with three conditions: SRT, MSRT, and Hygiene. All groups will report information about their sleep twice daily to a telephone answering machine. This will continue for a six-week period: two weeks of baseline data collection plus four weeks of treatment. The Hygiene group will control for transient changes in sleep patterns over time, and nonspecific effects of self-observation, telephone call-in, exposure to principles of sleep hygiene, problem-solving techniques, and therapist contact. Outcome assessments will include measures of 24TST, TST. WASO, SO, SE, and measures of subjective sleep quality. Hypothesis 2 (SideEffects) will be tested by measures taken before and after treatment on daytime sleepiness and attentional function. Additional Research Questions will address the issue of whether or not measures of depression and anxiety taken before and after treatment vary by treatment.

大部分的老年人群患有失眠。 催眠药物虽然提供短期缓解，但失去了功效 在几周内。另外，特别是对于老年人的催眠 药物可能会导致携带作用。行真健忘症和 加剧睡眠呼吸暂停。有效的非药理治疗 这个年龄组迫切需要失眠。 大多数现有关于失眠心理治疗的研究都集中在 关于年轻人。在较旧受试者中使用这种技术可能 需要新颖的方法和现有技术的修改。更改 应该反映睡眠维持的首要地位（反对睡眠潜伏期） 长者的问题和白天嗜睡的频率增加 团体。 我们建议研究最近据报道成功的治疗方法 年轻的失眠症，睡眠限制疗法（SRT）。 SRT改善睡眠 通过限制床上过多的时间并允许适度的应计质量 睡眠债务，导致睡眠合并。根据我们的最初 在老年人中，SRT的成功和经验，我们还将采用经过修改的 SRT（MSRT）作为第二种处理。在MSRT条件下将是 鼓励单午睡，精心安排在固定的 与他们的睡眠时间的时间关系。 SRT和MSRT条件都将是 与第三种条件（卫生）相比。我们的目标是评估治疗 对于老年失眠，不仅在改善睡眠方面，而且还在 在白天的功能和性能方面。 我们计划检验两个假设： 1。疗效假设：SRT和MSRT将改善社区的睡眠 通过提高睡眠效率（SE）和总睡眠时间来居住老年人 （TST）。通过减少睡眠的潜伏期（SO）， 与之相比 受试者处于卫生状态。 2。副作用假设：主观白天嗜睡将增加 在SRT条件下的受试者，但不适合MSRT条件下的受试者； 注意力措施的表现将在MSRT条件下提高，但 在SRT条件下将保持相同或下降。 假设1（功效）将在一项比较组研究中进行测试 三个条件：SRT，MSRT和卫生。所有小组都将报告 每天两次到电话接听机的信息。 这将持续六周：两周的基线数据 收集加四个星期的治疗。卫生组将控制 随着时间的流逝，睡眠方式的瞬态变化，以及非特异性的影响 自我观察，电话打电话，接触睡眠原理 卫生，解决问题的技术和治疗师接触。结果 评估将包括24tst，TST的措施。 Waso，SO，SE和措施 主观睡眠质量。假设2（副作用）将通过 治疗前后在白天嗜睡之前和之后采取的措施 注意功能。其他研究问题将解决这个问题 是否在之前和之后采取的抑郁症和焦虑措施 治疗因治疗而异。