Health Services Research & Development, Durham VA Health Care System, Durham, NC, United States.
Health Services Research & Development, Durham VA Health Care System, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
Clin Psychol Rev. 2018 Feb;59:118-125. doi: 10.1016/j.cpr.2017.11.005. Epub 2017 Nov 20.
Marked by difficulty falling or staying asleep and/or poor sleep leading to daytime dysfunction, insomnia contributes to functional impairment, poor health, and increased healthcare utilization when left untreated. As many as two-thirds of Iraq and Afghanistan military veterans complain of insomnia. Older veterans of prior conflicts report insomnia occurring since initial service, suggesting a chronic nature to insomnia in this population. Despite insomnia's high prevalence and severe consequences, there is no theoretical model to explain either the onset or chronicity of insomnia in this growing patient population. Existing theories view insomnia as an acute, unidirectional phenomenon and do little to elucidate long-term consequences of such problems. Existing theories also fail to address mechanisms by which acute insomnia becomes chronic. This paper presents an original, integrated theoretical model that draws upon constructs from several prominent behavioral medicine theories to reconceptualize insomnia as a chronic, cyclical problem that is both a consequence and predictor of stress. Additional research examining the relationships between stress, sleep, resilience, and outcomes of interest could inform clinical and research practices. Addressing sleep problems early could potentially enhance adaptive capacity, thereby reducing the risk for subsequent negative outcomes.
失眠的特点是难以入睡或保持睡眠，以及/或睡眠质量差，导致白天功能障碍，如果不加以治疗，会导致功能受损、健康状况不佳和医疗保健利用率增加。多达三分之二的伊拉克和阿富汗退伍军人抱怨失眠。先前冲突中的老年退伍军人报告说，他们从最初服役开始就出现失眠，这表明该人群的失眠具有慢性特征。尽管失眠的发病率很高，后果严重，但对于这一不断增长的患者群体，既没有理论模型可以解释失眠的发作，也没有理论模型可以解释失眠的慢性特征。现有理论将失眠视为一种急性、单向现象，几乎没有解释此类问题的长期后果。现有理论也未能解决急性失眠如何变为慢性失眠的机制问题。本文提出了一个原创的综合理论模型，该模型借鉴了几个著名的行为医学理论的概念，将失眠重新概念化为一种慢性、周期性的问题，既是压力的后果，也是压力的预测因素。更多研究关注压力、睡眠、韧性和相关结果之间的关系，可以为临床和研究实践提供信息。早期解决睡眠问题可能会增强适应能力，从而降低随后出现负面结果的风险。
