Czeisler C A, Richardson G S, Coleman R M, Zimmerman J C, Moore-Ede M C, Dement W C, Weitzman E D
Sleep. 1981;4(1):1-21. doi: 10.1093/sleep/4.1.1.
We report here the development of a brief drug-free rescheduling treatment ("chronotherapy") for Delayed Sleep Phase (DSP) insomnia, a syndrome characterized by sleep-onset insomnia with difficulty in morning awakening. We postulated that patients with DSP insomnia had an inadequate capacity to achieve phase advance shifts of the circadian pacemaker which times the sleep-wake cycle. Chronotherapy was therefore designed to reset these patients' biological clocks by the phase delay route. This single 5-6 day treatment was tested in 5 patients with a 4-15 year history of DSP insomnia. All 5 patients reported a lasting resolution of their symptoms substantiated by systematic long-term self-reports and objective polygraphic recording before and after treatment (average follow-up of 260 days; range, 42-910 days). The average sleep onset advanced from 4:50 a.m. before treatment to 12:20 a.m. afterwards, and wake times advanced from 1:00 p.m. to 755 a.m. (for both, p less than 0.001), with no reduction in sleep efficiency. As a result, all 5 patients were able to end their chronic dependence on hypnotic medications.
我们在此报告一种针对延迟睡眠相位（DSP）失眠的简短无药物重新调整治疗方法（“时间疗法”）的开发情况，DSP失眠是一种以入睡失眠且早晨觉醒困难为特征的综合征。我们推测，DSP失眠患者使昼夜节律起搏器进行相位提前转变的能力不足，而昼夜节律起搏器调节着睡眠 - 清醒周期。因此，时间疗法旨在通过相位延迟途径重置这些患者的生物钟。这种为期5 - 6天的单一治疗方法在5名有4 - 15年DSP失眠病史的患者中进行了测试。所有5名患者均报告其症状得到了持久缓解，这由治疗前后系统的长期自我报告和客观的多导睡眠图记录所证实（平均随访260天；范围为42 - 910天）。平均入睡时间从治疗前的凌晨4:50提前到了治疗后的凌晨12:20，起床时间从下午1:00提前到了上午7:55（两者p值均小于0.001），且睡眠效率没有降低。结果，所有5名患者都能够结束对催眠药物的长期依赖。
