美国睡眠专家阐述三个失眠理论,即三种因素(predisposing factors, or premorbid factors, precipitating factors, and perpetuated factors);急性失眠成因;perpetuated factors因素对其它失眠因素造成的叠加影响等。

Insomnia 3P_ Theory and Approach to Insomnia (Lecture 2)

Here is another MedCram lecture. We’re going to continue with our talk on insomnia. So here I’ve got, a graph that’s going to describe what the theory is in terms of insomnia, and how people get insomnia. This is a little bit of a graph here to explain over a number of months to years how this could happen.


So we’ve got in red here: predisposing factors. So what are predisposing factors? This is just the way you are made. It’s your genetics. It’s your tendency to have anxiety. It’s something that’s pre-wired. You can’t do anything about it. It’s just there.


Next one is the blue, which is the precipitating factor. You can’t control this either; something just happens in your life, either good stress or bad stress, you’re moving away to college, you’re getting married, you’re getting divorced, someone that’s born in the family disowned, or died in the family. So these are major life events. These are the precipitating factors.


Finally, these are perpetuating factors, which I will talk about. These are the things that we do to ourselves that are harmful in terms of our sleep hygiene, and keep us from having a good night’s sleep. So let’s talk about this a little bit here.


The first graph that I want to talk about is called the pre-morbid condition. What do I mean by this? If you can remember back to your childhood, this is how you were, you could sleep. Some people had problems sleeping their whole lives. But let’s just assume here that you are fine. Here is the premorbid condition, and this is just your genetics,  this is just how you are; there’s nothing you can do about it. This is the contribution of your genetics, otherwise known as predisposing factors, that are going to cause you to have problems.


Now you can see here. This is the summation of all the problems, and it’s well short of the threshold that’s going to cause insomnia. The spline is the insomnia threshold. So since you’re below the insomnia threshold, you don’t have insomnia now.


Let’s move on to the next phase in your life, and the next phase in your life is acute insomnia. Again, you cannot change, so you have your basic set of inherent factors that are part of you, that either do or don’t make you have a tendency to insomnia. But instead of just that, now you have major life stressors, and that major life stressors have a high enough magnitude that actually goes over the insomnia threshold. As a result of this, you have insomnia.


Okay. This is normal people have this all the time. They’ve got to test the next day. They have a major report that they have to do. They’ve got to go on a trip. This is all part of life. Sometimes it’s difficult to sleep in those situations; you can’t prevent that okay, but something happens.


Some people are well adapted. When this insomnia acute factor goes away, they go right back to normal and they have good sleep. However, in some people, early insomnia, something else that happens. Here again, are our predisposing factors. As the stress, it is still over the threshold, but as the stress from that insomnia starts to recede, we unwittingly begin to add these perpetuating factors. We’ll talk about what those perpetuating factors are very shortly.


But nonetheless, we add perpetuating factors until finally, we get to the situation of chronic insomnia. Now again, we have the thing that we cannot change, which is our predisposing factors, and the actual acute event may be very minimal. In fact, by itself, it would be well below the insomnia threshold, but because we have these perpetuating factors, and because we have unwittingly engaged in behaviors, we continue in a situation where we are still over the insomnia threshold.


If we could somehow figure out what we’re doing here and correct that, we could be down here enjoying a good night’s sleep. So the rest of these lectures are dedicated to figuring out what that stuff is and how to do something about it.


Now notice, I haven’t talked about sleep medication. We’re going to talk about what the societies that deal with insomnia recommend. Let’s talk about that very briefly before we end this video and go on to the next for insomnia.


The general approach that I use in the office. First, it is to look for diseases that could cause the patient to have insomnia; things like obstructive sleep apnea. Look at our videos on obstructive sleep apnea to get a better understanding about that. We look at sleep hygiene.


So we review a list that will talk about when we talk about stimulus control. This is very interesting, and we’ll talk specifically about stimulus control in the next couple of lectures. It’s only then after we’ve done that, that we still haven’t made headway that we start looking at behavioral therapy, and then finally medication. Notice how far down the list medication is for insomnia, and yet if you look at television and commercials, you’ll think that the first thing you should do if you can’t sleep is to take a sleeping pill. let’s talk about that and we’ll move on to the next lecture. See you next time.



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