105 失眠的臨床評估及護理處置 王俐潔王桂芸 * 摘要 : 失眠是睡眠障礙疾病中最常被抱怨的睡眠問題之一, 且在近年來被醫學界認為是嚴重影響人們生命和生活品質的一種疾病 本篇文章主要探討引起失眠的原因 造成的影響 可供使用的評估工具及照護重點, 護理人員若對失眠具有足夠的認知及採取合宜的處置, 並能實際運用於臨床工作, 可避免個體因失眠所造成的負面影響 關鍵詞 : 失眠 評估 處置 Charles, 2006Ohayon Shapiro Kennedy 2000 1870 45 65 32% Ohayon, 2002; Thomas & Timothy, 2003 Michel & Alison, 2004; Thomas & Timothy, 2003 Michel Alison 2004 American Psychiatric Association, 2000 American Academy of Sleep Medicine, 2005 Spielman Caruso Glovinsky 1987 3P predisposing factor precipitating factor perpetuating factor * 98 5 14 98 10 14 11490161 02 87923100 18766
106 Insomnia Evaluation and Management Arnedt, Conroy, Posner, & Aloia, 2006; Charles, 2006; Yang, Spielman, & Glovinsky, 2006 Arnedt et al., 2006; Charles, 2006; Thomas, Timothy, & Ron, 2007; Yang et al., 2006 ㈠ ㈡ : Arnedt et al., 2006; Charles, 2006; Yang et al., 2006 ㈠ Silber, 2006; Yang et al., 2006 ㈡ Pittsburgh Sleep Quality Index, PSQIBuysse Reynold Monk Berman Kupfer 1989 9 0 30 21 5 5 Buysses 1989 52 54 62 18 Cronbach s α.83 Buysses 1989 PSQI0.85 p <.01 Buysses 1989 PSQI polysomnography, PSG PSQI 89.6% 86.5% ㈠ polysomnography, PSG electroencephalography, EEG electrooculography, EOG electromyography, EMGelectrocardiography, ECG 2005 Arnedt et al., 2006; Silber, 2006
107 ㈡ Mutiple Sleep Latency Test, MSLT 2005 Arnedt et al., 2006; Silber, 2006 ㈢ actinography Silber, 2006 24 1 2 2005 Arnedt et al., 2006; Silber, 2006 ㈠ Benzodiazepine BZD Benzodiazepine receptor agonists BZRA BZD BZRA BZD1 Denise, Rhody, & James, 2006; Kalyanakrishnan & Dewey, 2007 ㈡ Melatonin melatonin melatonin Antonio, Sara, Julio, & Acacia, 2007 Wirz-Justice Armstrong 1996 melatonin 30 melatonin Antonio et al., 2007 ㈠ 20 2000 Charles, 2006; Yang et al., 2006 5 6 2000 Charles, 2006; Yang et al., 2006 ㈡ 2000 Charles, 2006; Yang et al., 2006 Total Sleep Time, TST TST Total Tim in Bed, TIB 5 TIB TST TIB / 100% TIBTIB 90%
108 Insomnia Evaluation and Management 15 30 85% 15 30 85% 90% 3 4 15 30 7 TIB ㈢ Charles, 2006 10 2-4 2000 Charles, 2006; Yang et al., 2006 ㈣ Yang et al., 2006 2000 Charles, 2006; Yang et al., 2006 Colin 2007 7 ㈤ 2000 Charles, 2006; Yang et al., 2006 2000 Charles, 2006; Yang et al., 2006 ㈥ chronotherapy 24 2 10 12 1 2 24 Thomas et al., 2007 1 2 2 3 2000 Charles, 2006; Yang et al., 2006
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110 Insomnia Evaluation and Management new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193 213. Charles, M. M. (2006). Cognitive-behavioral therapy of insomnia. Sleep Medicine Clinical, 1(3), 375 386. Colin, A. E., Kenneth, M. A., Mac, M., Heidi-Louise, K., Niall, M. B., Neil, J. D., et al. (2007). Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep, 30(5), 574 584. Denise, T. D., Rhody, D. E., & James, K. W. (2006). Pharmacologic management of insomnia: Past, present, and future. Psychiatry Clinical North American, 29(4), 871 893. Kalyanakrishnan, R., & Dewey, C. S. (2007). Treatment options for insomnia. American Family Physiciatry, 76(4), 517 528. Michel, B., & Alison, B. (2004). Is insomnia best categorized as a symptom or a disease? Sleep Medicine, 5(1), 35 40. Ohayon, M. M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6(2), 97 111. Ohayon, M., Shapiro, C. M., & Kennedy, S. H. (2000). Differentiating DSM-IV anxiety and depressive disorders in the general population: Comorbidity and treatment consequences. Canadian Journal of Psychiatry, 45(2), 166 172. Silber, M. M. (2006). The investigation of sleepiness. Sleep Medicine Clinical, 1(1), 1 7. Spielman, A. J., Caruso, L. S., Glovinsky, P. B. (1987). A behavioral perspective on insomnia treatment. Psychiatric Clinics of North America, 10(4), 541 53. Thomas, R., & Timothy, R. (2003). Insomnia: Epidemiology, characteristics, and consequences. Clinical Cornestone, 5(3), 5 16. Thomas, R., Timothy, R., & Ron, P. (2007). Insomnia: Pathophysiology and implications for treatment. Sleep Medicine Reviews, 11(1), 71 79. Wirz-Justice, A., & Armstrong, S. M. (1996). Melatonin: Nature s soporific? Sleep, 5(2), 137 141. Yang, C. M., Spielman, A. J., & Glovinsky, P. (2006). Nonpharmacologic strategies in the management of insomnia. Psychiatry Clinical North American, 29(4), 895 919. Insomnia: Clinical Evaluation and Nursing Management Li-Chieh Wang Kwua-Yun Wang * Abstract: The insomnia is one of the most frequent sleep disorders seen by physicians. It is currently recognized as a disease that greatly affects the daily routine and quality of life of sufferers. This article primarily discusses insomnia factors of influence, currently used evaluation tools, and the proper role of nursing care in treating insomnia. With adequate cognition and by employing adaptive management techniques, nurses can administer proper treatment to resolve patient insomnia problems. Key Words: insomnia, evaluation, management. RN, BSN, Graduate Student, School of Nursing, National Defense Medical Center; *RN, PhD, Assistant Director, Department of Nursing, Taipei Veterans General Hospital & Adjunct Professor, School of Nursing, National Defense Medical Center. Received: May 14, 2009 Revised: June 10, 2009 Accepted: October 14, 2009 Address correspondence to: Kwua-Yun Wang, No. 161, Min-Chuan E. Rd. Sec. 6, Taipei 11490, Taiwan, ROC. Tel: +886 (2) 8792-3100 ext. 18766; E-mail: w6688@mail.ndmctsgh.edu.tw