如何有好的睡眠 福遍中国教会 咨询中心（FB4C) David C Chao, M.D., FCCP 趙之嶽 Diplomat in Sleep Medicine- Diplomat in Pulmonary Medicine- Diplomat in Critical Care Medicine- American Board of Internal Medicine

人的一生將近三分之一的時間。剛出生的嬰兒睡二十個小時；成年人要睡七至八小時。

睡眠結構 非快速動眼睡眠 (NREM sleep)： 第Ⅰ期（淺睡期） 第Ⅱ期 第Ⅲ期（沉睡期）慢波 第Ⅳ期

日出而作, 日落而息 “Early to bed and early to rise, makes a man healthy, wealthy and wise.” ~Benjamin Franklin 睡眠剝奪（SLEEP DEPRIVATION） 老鼠的平均壽命為2-3 年；但如果不讓老鼠進入睡覺第五階段（快速動眼），牠們只能活5個星期；要是不讓老鼠睡覺，牠們只能活3個星期

Americans are not getting sufficient, quality sleep. 40% of Americans are NOT getting the 7-9 hours recommended for optimal health 75% experience sleep problems that affect the quality of their sleep

Excessive daytime sleepiness is a serious consequence of sleep deprivation. Daytime sleepiness affects all aspects of our lives. 37% of American adults experience daytime sleepiness that interferes with daily activities

Do you get enough sleep? What sleep? Do I have a sleep debt? Why does it matter? 睡眠債 不能一次償還,並要付出相當 的「利息」 變笨,變胖,變憂

夜猫子作息 睡眠相位后移症候群 (Delayed sleep phase disorder)

你有多睏--Are You Too Sleepy?   Total In a car, while stopped for a few minutes in traffic Sitting quietly after a lunch without alcohol Sitting and talking to someone Lying down in the afternoon As a passenger in a car for an hour Sitting, inactive, in a public place Watching TV Sitting and reading Chance of Dozing 0= would never doze 1= slight chance of dozing 2= moderate chance of dozing 3= high chance of dozing Situation Score of 9-15: you are very sleepy and should seek medical advice Score of 16 or greater: you are dangerously sleepy and should seek medical advice  

Wake Sleep

How much sleep is enough? 睡多少才夠?

良好睡眠…. 自療功能--消除疲勞,機體康復 記憶功能 --鞏固記憶,學習能力 代謝功能 --清垃圾,生長發育 免疫功能 --增強抗菌,抗癌 美容功能--護膚養顏瘦身,抗衰老

不良睡眠… 增加憂鬱症的機率 免疫功能低下 惡化各種精神,情緒的疾 病 記憶力下降 注意力不集中 增加倦勤怠工的情況 反應變慢 增加心臟血管問題 免疫功能低下 記憶力下降 注意力不集中 反應變慢 容貌變老,易胖 在美國每年因失眠的藥物花費加上生產力的降低， 大約要損失 1000 億美元。

失眠的因素： 性別– 女 年齡- 長 遺傳 生理時鐘 睡眠習慣,環境 生活型態- 獨 生活壓力- Stress 藥物 心理因素- 憂鬱,躁鬱,焦慮,精神錯亂 生理狀態,疾病

Medical Conditions Associated With Insomnia Cardiovascular disorders1,2 Endocrine disorders1,2 Gastrointestinal disorders1,2 Neurologic disorders3 Pulmonary disorders1,2 Rheumatic disorders1 Menopause4 1. Katz, McHorney, Arch Intern Med, 1998. 2. Rakel, J Fam Pract, 1993. 3. Thorpy In: Kryger et al, Principles and Practice of Sleep Medicine, 2000. 4. Owens, Matthews, Maturitas. 1998.

失眠（Insomnia) 10% 30% 入睡困難、不持續睡眠，或睡醒無精神 白天功能障礙

詩3:5-我躺下睡覺，我醒著，耶和華都保佑我。 詩4:8-我必平平安安躺下睡覺，因為只有你耶和華能使 我安然居住。 箴3:24 你躺下，必不懼怕；你躺臥，睡得香甜 (你躺下的時候，必不會驚恐；你躺臥的時候，必睡 得香甜 ) 詩127:2-你們清晨早起，夜晚安歇，吃勞碌得來的飯， 本是枉然；唯有耶和華所親愛的，必叫他安然睡覺。 (你們清早起來，很晚才歇息，吃勞碌得來的飯，都 是徒然；因為主必使他所愛的安睡 )  NIV / for while they sleep he provides... CJB : In vain do you get up early and put off going to bed, working hard to earn a living; for he provides for his beloved, even when they sleep.

失眠的治療 認知行為治療 CBT-I-- 睡眠衛生-- 時間, 環境, 吃喝, Caffeine, 菸, 酒, 睡前避免激烈運動 行為治療-- 不要強迫自己入睡, 逆向操作法(Paradoxical intention), 刺激控制治療法Stimulus Control (negative association/re- association)想睡時才上床, 睡不著起床, 定時起床 放鬆技巧訓練-- 冥想法肌肉放鬆法 藥物治療--抗組胺劑, 退黑激素, 苯二氮平（BZD）、BZD接受 器催動劑、抗憂鬱劑, 呼吸治療--哈佛醫師ANDREW WEIL, M.D.「478呼吸法」 其它治療--針灸, 藥膳, 足浴, 芳香療法, 助眠食物 認知行為治療 CBT-I--

認知行為治療 CBT-I

呼呼大睡– 可舒服? 又是個文明病 上呼吸道阻塞: 阻塞不完全=打鼾;完全阻塞= 呼吸暫停 (apnea) --睡眠呼吸中止症(OSA) 睡眠品質差;日間嗜睡疲累;夫妻感覺差 夜頻尿, 增加心臟、血管疾病的發生率 高血壓難控制

打鼾

How Common is Sleep Apnea? Impacts about 20 million American adults Prevalence similar to that of asthma 1 in 4 adults suffer from SDB 80 – 90% patients are undiagnosed and untreated Impacts all walks of life and all ages

睡眠呼吸中止症—診斷 多頻道睡眠記錄（polysomnography,PSG）

睡眠呼吸中止症—治療 一般性治療：維持理想體重、側睡、睡 前避免喝酒、避免服用安眠藥、減輕鼻 塞。 口腔矯正器 手術治療 正壓呼吸器(CPAP)

睡眠呼吸中止症 阻塞性 (obstructive apnea)： 在睡眠時發生呼吸道肌肉鬆弛，造成氣流部分 或完全阻斷。 中樞性 (central apnea)： 呼吸控制中樞發生功能障礙，刺激呼吸的神經 衝動暫時停止。 混合性 (mixed apnea)： 常發生於老年人，為上述二種類型的綜合。 周期性 (periodic breathing)： 心衰竭，高山症

不寧腿症候群 RLS: Restless Leg Syndrome 1.坐下或躺下時，一再的感覺到腿部有不舒適的感覺 ? 2.坐下或躺下時，一再的有想要移動腿的需求 或衝動 3.這些不適感或想動的衝動出現時，在休息狀 態(坐著或躺下) 時比在活動或走動時感覺更 嚴重 4.這些不適感或想動的衝動在傍晚或晚上時更 嚴重

週期性肢體動作障礙 PLMD- Periodic Limb Movement Disorder PLMS: repetitive, highly stereotyped, limb movements Duration: 0.5~5 sec. In a sequence of ≧4 movements An interval between movements 4~90 sec (usually 20-40 sec). PLMD: PLMS index > 15/hr, with …. Clinical sleep disturbance or daytime fatigue PLMS ≧5 in 80~90% of patients with RLS

使用多巴安藥物Dopamine agonist or DA precursors 不寧腿症候群或週期性肢體動作障礙 治療 治療缺鐵問題 使用多巴安藥物Dopamine agonist or DA precursors Ropinirol 0.25~4 mg hs Pergolide 0.1~0.5 mg hs 鎮靜肌肉鬆弛劑 Clonazepam 0.5~2 mg Gabapentin

發作性昏睡(narcolepsy) 罕見的遺傳性疾病，又稱為嗜睡症 (ESS20) 突然進入睡眠狀態“猝倒” (cataplexy) 立即可進入快速動眼期睡眠 (sleep-onset REM) 產生入眠幻覺“假醒” –(hypnogogic/pompic hallucination) 睡眠麻痺/癱瘓–(sleep paralysis) “鬼壓床” 易發生在過度疲勞，醉酒的人身上。

建立良好的睡眠習慣 Keep a regular bed and wake time schedule—including weekends Establish a regular bedtime routine. About an hour before going to bed: Engage in a relaxing, non-alerting activity Do not drink or eat too much Maintain a quiet, dark and preferably cool, but comfortable sleep environment

Sleep Tips (cont’d) During the day: Finish eating at least 2-3 hours before bedtime Avoid caffeine, alcohol and nicotine late in the day Exercise, but not too close to bedtime Avoid napping late in the day During sleep, we experience two alternating types or states of sleep over an 8-hour time period: NREM sleep and REM sleep. The cycle repeats itself every 90 minutes. This slide shows you our sleep architecture.   NREM or Non-Rapid Eye Movement includes 4 stages of sleep. As we shut our eyes for sleep, we first enter light sleep or Stage 1, the link between being awake and falling asleep. Stage 2 marks the actual onset of sleep when you become disengaged from the environment, breathing and heart rate are regular and body temperature continues to go down. We spend about ½ of our sleep cycle in the first two stages. Stage 3 and 4 are the deepest states of sleep when we experience the most restorative sleep, so essential to functioning. Muscles are completely relaxed, blood pressure drops and breathing is slower. During these deep stages of sleep, blood supply to the muscles is increased, energy is restored, tissue growth and repair occur and important hormones are released for growth and development. REM or Rapid-Eye Movement sleep occurs increasingly over the later part of the night and is also necessary for providing energy to our brains and body. During REM sleep, our brains are active and dreaming occurs. As we enter REM sleep, our bodies actually become immobile, muscles shut down, and again, we are relaxed. Breathing and heart rate may become irregular. During this stage of active brain activity, the eyes dart back and forth under the eyelids - giving REM sleep its name. Because getting enough REM sleep may contribute to memory consolidation, it is especially important following a learning experience. REM sleep typically comprises about ¼ of our night.

睡眠與憂鬱 因果 睡眠結構 夢的本質

Depression Often caused by worry about needs not being met: Safety/Security Significance/Meaning Intimacy/Connection