-
Sleep vs. Wake/ArousalHomeostatic SystemCircadian SystemArousal
System
-
/
-
Two-process Model of Sleep Regulation (Homeostatic System;
Process S)/ (Circadian System; Process C)
-
/Adenosine
-
24/: Suprachiasmatic nucleus (SCN)Dorsomedial hypothalamus
(DHM)
-
20 hours/day Core body temperature & Melatonin rhythms = 24
hrs 15 mins(Czeisler, 2000)
-
(Forced desynchrony protocol)
-
v.s. Melanopsin in ganglion cellsRetinothalamic tractSCN()PRC of
light on phase shiftingShort wavelengths (470nm; blue light) are
most effective.
-
SCN Lesion Studies
-
/Activate thalamic relay neurons & reticular nucleus of the
thalamusProject to lateral hypothalamic area & BF, and
throughout the cerebral cortex
-
Sleep vs. Wake/ArousalHomeostatic SystemCircadian SystemArousal
SystemBehavioral PracticesSleep CognitionEmotional
ArousalPsychological/Behavioral FacotrsNeurophysiological
Systems
-
Cognitive Model of Insomnia (Harvey, 2002)
-
Predisposing FactorIndividual characteristic to set the stage
for the development of insomniaPrecipitating FactorThe event that
triggers the onset of insomniaPerpetuating FactorThe factors that
maintain the continuation of insomnia3P Model of the Development of
Insomnia(Spielman AJ et al., 1986)
-
/
-
/
-
24/ /
-
35
-
24
-
Light Therapy for DSPS
-
//
-
105
-
polysomnography,PSG
-
(CPAP)
-
- /
-
-
-
DIY/
-
http://tssm.org.tw
-
Components of CBT for Insomnia Education ComponentUnderstand
sleep mechanismsUnderstand sleep pathologiesSleep hygiene
practicesBehavioral ComponentSleep scheduling: stimulus control
& sleep restrictionRelaxation trainingAdjusting circadian
clockMedication taperingCognitive ComponentCognitive
restructuringParadoxical intensionStress management
-
CBT vs. Hypnotic for Sleep Maintenance Insomnia in Elderly Morin
et al. JAMA 1999; 281:991-999.
Graph2
49.5822.2928.3721.2233.06
55.0929.4834.8244.9750.5
56.9620.7834.9533.5739.67
62.2451.7361.1463.2159.93
Pre
Post
FU3
FU12
FU24
Wake After Sleep Onset (min)
Feuil1
Sleep Onset LatencyWake After Sleep OnsetTotal Sleep Time
Pre64.370.334
Post36.637.662
FU32.537.881
SOLWASOTST
Pre23.231.343.9
Post15.815.741
FU16.620.544.5
CBTMedCombPlacebo
Pre49.5855.0956.9662.24
Post22.2929.4820.7851.73
FU328.3734.8234.9561.14
FU1221.2244.9733.5763.21
FU2433.0650.539.6759.93
Feuil1
00023.215.816.6
00031.315.720.5
00043.94144.5
Pre
Post
FU
Feuil2
00000
00000
00000
00000
Pre
Post
FU3
FU12
FU24
Feuil3
-
CBT vs. Hypnotic for Sleep-Onset Insomnia(Jacobs, G.D., et al.
Ach Intern Medicine 2004;164: 1888-1896)
-
Chart4
20.299.53
16.9711.39
14.9115.55
Pre-Treatment
Post-Treatment
ISI Total Score
Sheet1
SOL
+
60.6838.3143.7
38.5135.8245.97
CBT60.6838.51
COM38.3135.82
PT43.745.97
WASO
+
27.3425.9626.33
13.5711.4918.17
CBT27.3413.57
COM25.9611.49
PT26.3318.17
TST
+
380.53388.37372.92
412.42407.65370.51
CBT380.53412.42
COM388.37407.65
PT372.92370.51
TIB
CBTCPTPT
488.12491.95475.19
487476.78469.15
SE
CBTCPTPT
78.1679.0478.79
84.7485.3479
CBT78.1684.74
COM79.0485.34
PT78.7979
ISI
CBTICBTI + MedicationMedication
Pre-Treatment20.2916.9714.91
Post-Treatment9.5311.3915.55
CBT20.299.53
COM16.9711.39
PT14.9115.55
DBAS
CBTCPTPT
153.88169.06152.5
108.29128.74155.5
CBT153.88108.29
COM169.06128.74
PT152.5155.5
DBAS1
CBTCPTPT
40.564343.91
29.8935.2443.36
CBT49.2436.71
COM50.3842.47
PT53.5654.89
DBAS2
CBTCPTPT
46.6549.5342.91
28.4734.4741.73
CBT46.6528.47
COM49.5334.47
PT42.9141.73
DBAS3
CBTCPTPT
16.2816.6416.3
13.7214.5515.9
CBT16.2813.72
COM16.6414.55
PT16.315.9
DBAS4
CBTCPTPT
8.58.536.64
5.677.718.18
CBT8.55.67
COM8.537.71
PT6.648.18
DBAS5
CBTCPTPT
31.563833.6
19.528.0336.8
CBT38.4123.18
COM43.3531.94
PT3940.75
PSAS_S
CBTCPTPT
15.8814.9413.89
13.8213.914.89
CBT15.8813.82
COM14.9413.9
PT13.8914.89
PSAS_C
CBTCPTPT
25.5323.7319.55
2019.2720.91
CBT25.5320
COM23.7319.27
PT19.5520.91
SHPS_1
CBTCPTPT
19.3919.4517.11
18.6716.3315.89
CBT19.3918.67
COM19.4516.33
PT17.1115.89
SHC_2
CBTCPTPT
22.9423.5222.64
22.7820.9721.18
CBT22.9422.78
COM23.5220.97
PT22.6421.18
SHC_3
CBTCPTPT
12.221415
12.8912.7612.64
CBT12.2212.89
COM1412.76
PT1512.64
SHC_4
CBTCPTPT
24.832827.55
21.0621.0628.64
CBT24.8321.06
COM2821.06
PT27.5528.64
Sheet1
00
00
00
Sheet2
00
00
00
Sheet3
00
00
00
00
00
00
00
00
00
Pre-Treatment
Post-Treatment
ISI
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
00
00
00
00
00
00
00
00
00
12.2212.89
1412.76
1512.64
00
00
00
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
(%)
000
000
CBT
COM
PT
ISI
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
24.832827.55
21.0621.0628.64
CBT
COM
PT
00
00
00
00
00
00
00
00
00
Pre-Treatment
Post-Treatment
-
Chart2
60.6838.51
38.3135.82
43.745.97
Pre-Treatment
Post-Treatment
SOL (min)
Sheet1
SOL
CBTICBTI + MedicationMedication
Pre-Treatment60.6838.3143.7
Post-Treatment38.5135.8245.97
CBT60.6838.51
COM38.3135.82
PT43.745.97
WASO
CBTCPTPT
27.3425.9626.33
13.5711.4918.17
CBT27.3413.57
COM25.9611.49
PT26.3318.17
TST
CBTCPTPT
380.53388.37372.92
412.42407.65370.51
CBT380.53412.42
COM388.37407.65
PT372.92370.51
TIB
CBTCPTPT
488.12491.95475.19
487476.78469.15
SE
CBTCPTPT
78.1679.0478.79
84.7485.3479
CBT78.1684.74
COM79.0485.34
PT78.7979
ISI
CBTCPTPT
20.2916.9714.91
9.5311.3915.55
CBT20.299.53
COM16.9711.39
PT14.9115.55
DBAS
CBTCPTPT
153.88169.06152.5
108.29128.74155.5
CBT153.88108.29
COM169.06128.74
PT152.5155.5
DBAS1
CBTCPTPT
40.564343.91
29.8935.2443.36
CBT49.2436.71
COM50.3842.47
PT53.5654.89
DBAS2
CBTCPTPT
46.6549.5342.91
28.4734.4741.73
CBT46.6528.47
COM49.5334.47
PT42.9141.73
DBAS3
CBTCPTPT
16.2816.6416.3
13.7214.5515.9
CBT16.2813.72
COM16.6414.55
PT16.315.9
DBAS4
CBTCPTPT
8.58.536.64
5.677.718.18
CBT8.55.67
COM8.537.71
PT6.648.18
DBAS5
CBTCPTPT
31.563833.6
19.528.0336.8
CBT38.4123.18
COM43.3531.94
PT3940.75
PSAS_S
CBTCPTPT
15.8814.9413.89
13.8213.914.89
CBT15.8813.82
COM14.9413.9
PT13.8914.89
PSAS_C
CBTCPTPT
25.5323.7319.55
2019.2720.91
CBT25.5320
COM23.7319.27
PT19.5520.91
SHPS_1
CBTCPTPT
19.3919.4517.11
18.6716.3315.89
CBT19.3918.67
COM19.4516.33
PT17.1115.89
SHC_2
CBTCPTPT
22.9423.5222.64
22.7820.9721.18
CBT22.9422.78
COM23.5220.97
PT22.6421.18
SHC_3
CBTCPTPT
12.221415
12.8912.7612.64
CBT12.2212.89
COM1412.76
PT1512.64
SHC_4
CBTCPTPT
24.832827.55
21.0621.0628.64
CBT24.8321.06
COM2821.06
PT27.5528.64
Sheet1
Pre-Treatment
Post-Treatment
Sheet2
00
00
00
Sheet3
00
00
00
00
00
00
00
00
00
00
00
00
ISI
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
00
00
00
00
00
00
00
00
00
12.2212.89
1412.76
1512.64
00
00
00
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
(%)
000
000
CBT
COM
PT
ISI
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
24.832827.55
21.0621.0628.64
CBT
COM
PT
Pre-Treatment
Post-Treatment
-
Chart5
27.3413.57
25.9611.49
26.3318.17
Pre-Treatment
Post-Treatment
WASO (min)
Sheet1
SOL
+
60.6838.3143.7
38.5135.8245.97
CBT60.6838.51
COM38.3135.82
PT43.745.97
WASO
CBTICBTI + MedicationMedication
Pre-Treatment27.3425.9626.33
Post-Treatment13.5711.4918.17
CBT27.3413.57
COM25.9611.49
PT26.3318.17
TST
CBTCPTPT
380.53388.37372.92
412.42407.65370.51
CBT380.53412.42
COM388.37407.65
PT372.92370.51
TIB
CBTCPTPT
488.12491.95475.19
487476.78469.15
SE
CBTCPTPT
78.1679.0478.79
84.7485.3479
CBT78.1684.74
COM79.0485.34
PT78.7979
ISI
CBTCPTPT
20.2916.9714.91
9.5311.3915.55
CBT20.299.53
COM16.9711.39
PT14.9115.55
DBAS
CBTCPTPT
153.88169.06152.5
108.29128.74155.5
CBT153.88108.29
COM169.06128.74
PT152.5155.5
DBAS1
CBTCPTPT
40.564343.91
29.8935.2443.36
CBT49.2436.71
COM50.3842.47
PT53.5654.89
DBAS2
CBTCPTPT
46.6549.5342.91
28.4734.4741.73
CBT46.6528.47
COM49.5334.47
PT42.9141.73
DBAS3
CBTCPTPT
16.2816.6416.3
13.7214.5515.9
CBT16.2813.72
COM16.6414.55
PT16.315.9
DBAS4
CBTCPTPT
8.58.536.64
5.677.718.18
CBT8.55.67
COM8.537.71
PT6.648.18
DBAS5
CBTCPTPT
31.563833.6
19.528.0336.8
CBT38.4123.18
COM43.3531.94
PT3940.75
PSAS_S
CBTCPTPT
15.8814.9413.89
13.8213.914.89
CBT15.8813.82
COM14.9413.9
PT13.8914.89
PSAS_C
CBTCPTPT
25.5323.7319.55
2019.2720.91
CBT25.5320
COM23.7319.27
PT19.5520.91
SHPS_1
CBTCPTPT
19.3919.4517.11
18.6716.3315.89
CBT19.3918.67
COM19.4516.33
PT17.1115.89
SHC_2
CBTCPTPT
22.9423.5222.64
22.7820.9721.18
CBT22.9422.78
COM23.5220.97
PT22.6421.18
SHC_3
CBTCPTPT
12.221415
12.8912.7612.64
CBT12.2212.89
COM1412.76
PT1512.64
SHC_4
CBTCPTPT
24.832827.55
21.0621.0628.64
CBT24.8321.06
COM2821.06
PT27.5528.64
Sheet1
Sheet2
Pre-Treatment
Post-Treatment
Sheet3
00
00
00
00
00
00
00
00
00
ISI
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
00
00
00
00
00
00
00
00
00
12.2212.89
1412.76
1512.64
00
00
00
CBT
COM
PT
()
CBT
COM
PT
()
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
(%)
000
000
CBT
COM
PT
ISI
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
24.832827.55
21.0621.0628.64
CBT
COM
PT
Pre-Treatment
Post-Treatment
WASO (min)
-
Chart10
380.53412.42
388.37407.65
372.92370.51
Pre-Treatment
Post-Treatment
TST (min)
Sheet1
SOL
+
60.6838.3143.7
38.5135.8245.97
CBT60.6838.51
COM38.3135.82
PT43.745.97
WASO
+
27.3425.9626.33
13.5711.4918.17
CBT27.3413.57
COM25.9611.49
PT26.3318.17
TST
CBTICBTI + MedicationMedication
Pre-Treatment380.53388.37372.92
Post-Treatment412.42407.65370.51
CBT380.53412.42
COM388.37407.65
PT372.92370.51
TIB
CBTCPTPT
488.12491.95475.19
487476.78469.15
SE
CBTCPTPT
78.1679.0478.79
84.7485.3479
CBT78.1684.74
COM79.0485.34
PT78.7979
ISI
CBTCPTPT
20.2916.9714.91
9.5311.3915.55
CBT20.299.53
COM16.9711.39
PT14.9115.55
DBAS
CBTCPTPT
153.88169.06152.5
108.29128.74155.5
CBT153.88108.29
COM169.06128.74
PT152.5155.5
DBAS1
CBTCPTPT
40.564343.91
29.8935.2443.36
CBT49.2436.71
COM50.3842.47
PT53.5654.89
DBAS2
CBTCPTPT
46.6549.5342.91
28.4734.4741.73
CBT46.6528.47
COM49.5334.47
PT42.9141.73
DBAS3
CBTCPTPT
16.2816.6416.3
13.7214.5515.9
CBT16.2813.72
COM16.6414.55
PT16.315.9
DBAS4
CBTCPTPT
8.58.536.64
5.677.718.18
CBT8.55.67
COM8.537.71
PT6.648.18
DBAS5
CBTCPTPT
31.563833.6
19.528.0336.8
CBT38.4123.18
COM43.3531.94
PT3940.75
PSAS_S
CBTCPTPT
15.8814.9413.89
13.8213.914.89
CBT15.8813.82
COM14.9413.9
PT13.8914.89
PSAS_C
CBTCPTPT
25.5323.7319.55
2019.2720.91
CBT25.5320
COM23.7319.27
PT19.5520.91
SHPS_1
CBTCPTPT
19.3919.4517.11
18.6716.3315.89
CBT19.3918.67
COM19.4516.33
PT17.1115.89
SHC_2
CBTCPTPT
22.9423.5222.64
22.7820.9721.18
CBT22.9422.78
COM23.5220.97
PT22.6421.18
SHC_3
CBTCPTPT
12.221415
12.8912.7612.64
CBT12.2212.89
COM1412.76
PT1512.64
SHC_4
CBTCPTPT
24.832827.55
21.0621.0628.64
CBT24.8321.06
COM2821.06
PT27.5528.64
Sheet1
00
00
00
Sheet2
00
00
00
Sheet3
Pre-Treatment
Post-Treatment
00
00
00
00
00
00
00
00
00
ISI
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
DBAS
00
00
00
00
00
00
00
00
00
00
00
00
12.2212.89
1412.76
1512.64
00
00
00
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
()
000
000
CBT
COM
PT
(%)
000
000
CBT
COM
PT
ISI
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
DBAS
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
000
000
CBT
COM
PT
24.832827.55
21.0621.0628.64
CBT
COM
PT
00
00
00
Pre-Treatment
Post-Treatment
-
Have a Nice Sleep!!
REMREMOutputREMREMREMREM()VLPO do not accumulate a need to
sleep, as they remain at a low level of activity after prolonged
sleep deprivation.Prolonged wakefulness energy producing systems
run down: ATP ADP, AMP adenosine (extracellular adenosine in BF)
VLPO activities
()3624
2415470nm()
REMREM()1.2.3.()CS2500lux*****
![日本睡眠改善協議会 · 2010. 2. 26. · 日本睡眠改善協議会 2. 睡眠ポリグラフ記録 [睡眠段階判定のための電極部位（国際基準）] 眼電図](https://img.pdfslide.tips/doc/110x75/603110886ab684667f12b809/oeccoee-2010-2-26-oeccoee-2-ccoeffffeeoe.jpg)
