BACKGROUND & AIMS: A yoked control study used sleep recordings from 10 insomniacs to produce similar sleep patterns in a group of matched normal sleepers for 7 nights to determine if specific electroencephalographic (EEG) sleep patterns were responsible for the secondary insomnia symptoms reported by the insomniacs. Specifically, it was found that insomniacs display increased tension/confusion, decreased vigor, personality disturbance, subjective over-estimation of poor sleep, increased body temperature, increased 24-hour whole body metabolic rate, and increased multiple sleep latency test (MSLT) values. Normal sleepers given the nocturnal EEG parameters of insomniacs displayed decreased tension, decreased vigor, decreased body temperature, and decreased MSLT values. The spectrum of changes seen in the normal sleepers given an insomniac sleep pattern was characteristic of mild partial sleep deprivation and not consistent with symptoms found in patients with primary insomnia. It was concluded that the secondary symptoms reported by patients with primary insomnia are probably not related to their poor sleep per se. Data from previous studies that varied physiological arousal were used to support the contention that the secondary symptoms of insomnia, including poor sleep, occur secondary to central nervous system hyperarousal.

背景与目标： 一项带轭的对照研究使用了10个失眠症的睡眠记录，在一组匹配的正常睡眠者中产生了7个晚上的相似睡眠模式，以确定特定的脑电图（EEG）睡眠形态是否是失眠症患者报告的继发性失眠症状的原因。具体而言，发现失眠症患者会表现出紧张/精神错乱，精力下降，人格障碍，对睡眠不足的主观估计过高，体温升高，24小时全身新陈代谢率升高以及多次睡眠潜伏期测试（MSLT）值升高。夜间睡眠时脑电图参数失眠的正常睡眠者表现出紧张度降低，活力降低，体温降低和MSLT值降低。给定失眠睡眠模式的正常睡眠者所见变化范围是轻度部分睡眠剥夺的特征，并且与原发性失眠患者的症状不一致。结论是，原发性失眠患者报告的继发症状可能与其睡眠不良有关。来自先前研究的各种生理刺激的数据被用来支持这样的论点，即失眠的继发症状，包括睡眠不足，是继发于中枢神经系统亢奋的。

BACKGROUND & AIMS: STUDY OBJECTIVES:To explore the sleep onset process in primary insomnia patients, new rules for scoring 4-second epochs were implemented to score sleep and artifacts during initial sleep onset. Conventional scorings in 20-second and 60-second epochs were also obtained. METHODS:The start of the initial 60-second epoch of stage 1 was used to define "time zero" (t0). Sleep onset periods from 11 patients and 11 individually age- and sex-matched controls spanned from 5 minutes before t0 through 29 minutes after t0. Using the new rules, the periods were scored blind to group assignment. This t0 time-referenced the data analysis to one plausible midpoint in the sleep onset process. In parallel, latencies were time-referenced from good night time. RESULTS:Reliability in scoring sleep and artifacts was adequate (kappa = 0.68 & 0.63, respectively, p <0.001). Group differences in sleep latencies were marginal in 60-second and 20-second scoring but significant with a definition of 4-second sleep latency. Patients had more 4-second epochs scored as awake (Mantel-Haenszel chi2 = 271, d.f. = 1, p <0.001) and containing artifact (M-H chi2 = 143, p <0.001). Patients took longer to achieve 30 continuous 4-second epochs of NREM sleep (Breslow chi2 = 4.03, d.f. = 1, p = 0.045) after t0. Patients accumulated sleep more slowly with all 3 scoring rules after t0. A slower rate of accumulating sleep after t0 was detected only with the 4-second scoring (p = 0.047). CONCLUSIONS:Evidence was present for momentary state-switching instabilities in the patients during the initial sleep onset process. Using rules for scoring small epochs may reveal such instabilities more readily than traditional scoring methods.

背景与目标： 研究目的：为了探讨原发性失眠患者的睡眠发作过程，实施了对4秒内评分的新规则，以对初始睡眠发作期间的睡眠和假象进行评分。还获得了20秒和60秒内的常规得分。
方法：从阶段1的最初60秒开始，开始定义“时间零”（t0）。 11位患者和11位年龄和性别相匹配的对照的睡眠发作期从t0之前的5分钟到t0之后的29分钟。使用新规则，对期间进行了盲目评分以进行小组分配。这在睡眠发作过程中将数据分析时间参考了一个合理的中点。同时，从晚安时间开始，延迟就以时间为基准。
结果：对睡眠和伪像评分的可靠性足够（kappa分别为0.68和0.63，p <0.001）。在60秒和20秒的评分中，睡眠延迟的组间差异很小，但以4秒的睡眠延迟定义很明显。患者在清醒时得分更高的4秒时间段（Mantel-Haenszel chi2 = 271，d.f. = 1，p <0.001）并且包含伪影（M-H chi2 = 143，p <0.001）。患者在t0后花了更长的时间才能达到NREM睡眠连续30个4秒钟的时间（Breslow chi2 = 4.03，d.f。= 1，p = 0.045）。在t0之后，使用所有3个评分规则，患者的睡眠积累都更加缓慢。仅在4秒评分中才检测到t0之后积累睡眠的速度较慢（p = 0.047）。
结论：存在证据表明患者在最初的睡眠发作过程中存在短暂的状态转换不稳定性。使用规则对小时期进行评分可能比传统的评分方法更容易揭示这种不稳定性。

BACKGROUND & AIMS: OBJECTIVE:Insomnia is a debilitating comorbidity of chronic pain. This pilot trial tested the utility of a hybrid treatment that simultaneously targets insomnia and pain-related interference. METHODS:Chronic pain patients with clinical insomnia were randomly allocated to receive 4 weekly 2-h sessions of hybrid treatment (Hybrid Group; n = 10) or to keep a pain and sleep diary for 4 weeks, before receiving the hybrid treatment (Monitoring Group; n = 10). Participants were assessed at the beginning and end of this 4-week period. Primary outcomes were insomnia severity and pain interference. Secondary outcomes were fatigue, anxiety, depression and pain intensity. Ancillary information about the hybrid treatment's effect on psychological processes and sleep (as measured with sleep diary and actigraphy) are also presented, alongside data demonstrating the treatment's clinical significance, acceptability and durability after one and six months. Data from all participants (n = 20) were combined for this purpose. RESULTS:Compared to symptom monitoring, the hybrid intervention was associated with greater improvement in sleep (as measured with the Insomnia Severity Index and sleep diary) at post-treatment. Although pain intensity did not change, the Hybrid Group reported greater reductions in pain interference, fatigue and depression than the Monitoring Group. Overall, changes associated with the hybrid intervention were clinically significant and durable at 1- and 6-month follow-ups. Participants also rated highly on treatment acceptability. CONCLUSION:The hybrid intervention appeared to be an effective treatment for chronic pain patients with insomnia. It may be a treatment approach more suited to tackle challenges presented in clinical practice, where problems seldom occur in isolation.

背景与目标： 目的：失眠症是一种使慢性疼痛衰弱的合并症。这项试验性试验测试了同时针对失眠和疼痛相关干扰的混合疗法的实用性。
方法：将临床失眠的慢性疼痛患者随机分配至接受混合治疗前的每周2 h混合疗法疗程（Hybrid组; n = 10）或保持疼痛和睡眠日记4周（监测组） ; n = 10）。在这4周的开始和结束时对参与者进行评估。主要结果是失眠严重程度和疼痛干扰。次要结果是疲劳，焦虑，抑郁和疼痛强度。还提供了有关混合疗法对心理过程和睡眠的影响的辅助信息（通过睡眠日记和书法记录），并显示了该疗法在一个月和六个月后的临床意义，可接受性和持久性的数据。为此，将所有参与者（n = 20）的数据合并在一起。
结果：与症状监测相比，混合干预与治疗后的睡眠改善（通过失眠严重度指数和睡眠日记测量）有关。尽管疼痛强度没有改变，但混合动力组报告的疼痛干扰，疲劳和抑郁感减轻程度比监测组更大。总体而言，与混合干预相关的变化在1个月和6个月的随访中具有临床意义和持久性。参与者在治疗可接受性方面也给予很高的评价。
结论：混合干预似乎是治疗慢性疼痛失眠患者的有效方法。这可能是一种更适合解决临床实践中出现的挑战的治疗方法，在临床实践中，很少会孤立地出现问题。

BACKGROUND & AIMS: :Objective/Background: Insomnia is a pervasive and costly disorder that is particularly prevalent within the U.S. Veteran population. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first-line treatment for insomnia, high rates of sedative-hypnotic prescribing continue. There is little research investigating the rates and factors impacting insomnia treatment recommendations, both behavioral and pharmacological. Participants: A cohort of 5,254 Veterans referred for either CBT-I or prescribed a sedative-hypnotic medication at a single VA Medical Center composed the group of participants. Methods: The current study evaluated the rates of insomnia treatment recommendations and the extent to which demographic variables, psychiatric disorders, and sleep disorders contributed to referrals for CBT-I or prescriptions for sedative-hypnotic medications within a large administrative data set. Results: Military service-related disability, insomnia diagnosis, and having one or more psychiatric diagnoses were associated with a greater likelihood of receiving a CBT-I referral (alone or in addition to a sedative-hypnotic medication) rather than a sedative-hypnotic prescription alone. A diagnosis of posttraumatic stress disorder was associated with a greater likelihood of receiving a sedative-hypnotic medication alone versus a CBT-I referral. Conclusions: Overall, the findings suggest that sedative-hypnotic medications were overwhelmingly the primary treatment recommendation despite evidence to support CBT-I as the recommended first-line treatment. However, key factors were identified that increased the likelihood of Veterans being referred for CBT-I. Suggestions for better identifying and understanding key factors that impact treatment recommendations are discussed.

背景与目标： ：目的/背景：失眠是一种普遍且代价高昂的疾病，在美国退伍军人人群中尤为普遍。尽管推荐的失眠认知行为疗法（CBT-1）是一线治疗失眠症，但镇静催眠处方的使用率仍然很高。很少有研究调查失眠治疗建议的发生率和因素，包括行为学和药理学。参与者：由5254名退伍军人组成的队列，由一组VA医疗中心转介参加CBT-1或开具镇静催眠药。方法：本研究评估了失眠治疗建议的比率以及人口统计变量，精神疾病和睡眠障碍在多大行政数据集中促成转诊CBT-1或镇静催眠药物处方的程度。结果：与军事服务有关的残疾，失眠诊断以及进行一项或多项精神病诊断与接受CBT-I转诊（单独或除镇静催眠药物之外）而非镇静催眠处方的可能性更大。独自的。创伤后应激障碍的诊断与单独接受镇静催眠药物相比，与CBT-1转诊的可能性更大。结论：总的来说，研究结果表明，尽管有证据支持镇静催眠药物支持CBT-1作为推荐的一线治疗，但绝大多数还是主要的推荐治疗药物。但是，已确定了关键因素，这些因素增加了退伍军人转介CBT-1的可能性。讨论了有关更好地识别和理解影响治疗建议的关键因素的建议。

BACKGROUND & AIMS: :Do patients with primary insomnia differ from good sleepers with respect to the number or duration of awakenings or to the stages from which awakenings occur? To address this question, polysomnography (PSG) records were evaluated in 10 good sleepers (GS) and 10 primary insomnia patients (PI). PSG records were evaluated for occurrence and duration of awakenings and for the stage immediately preceding each awakening. PIs woke more frequently and for longer durations than did GSs. PIs' awakenings tended to occur from Stages 1 or 2; GSs' occurred from epochs scored as movement times. The data from this study represent the first attempt to characterize the stages from which awakenings occur in sleep maintenance insomnia.

背景与目标： ：原发性失眠患者的觉醒次数或持续时间或觉醒发生的阶段是否与良好的睡眠者有所不同？为了解决这个问题，对10位良好睡眠者（GS）和10位原发性失眠患者（PI）进行了多导睡眠监测（PSG）记录评估。对PSG记录的觉醒发生时间和持续时间以及每次觉醒之前的阶段进行了评估。与GS相比，PI的唤醒频率更高，持续时间更长。 PI的唤醒通常发生在第1或第2阶段。 GSs是从记为运动时间的时代开始的。这项研究的数据代表了首次尝试表征睡眠维持性失眠的觉醒阶段。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Cognitive therapy has been shown effective in the treatment of several psychological and health-related disorders. It is also increasingly used in the management of insomnia. This article outlines some principles and applications of this therapeutic approach as adapted to the treatment of insomnia. Based on Beck's model, this psychotherapeutic approach seeks to modify sleep-related dysfunctional beliefs and thoughts and maladaptive cognitive processes involved in the exacerbation and perpetuation of insomnia. This is accomplished through the use of several cognitive restructuring procedures. After outlining a conceptual model of insomnia, which emphasizes the mediating role of dysfunctional cognitions in the development and maintenance of chronic insomnia, the rationale and general principles of cognitive therapy for insomnia are presented, followed by a description of the treatment procedures, clinical case illustrations, and practical implementation issues. Future directions include the need to refine cognitive interventions and to examine the unique contribution of this therapeutic component to the overall efficacy of multifaceted cognitive-behavioral therapy.

背景与目标： ：认知疗法已被证明可有效治疗多种心理和健康相关疾病。它也越来越多地用于失眠的管理。本文概述了适用于失眠治疗的这种治疗方法的一些原理和应用。根据贝克的模型，这种心理治疗方法旨在改变与睡眠有关的功能障碍的信念和思想，以及与失眠加重和永存有关的适应不良的认知过程。这是通过使用几种认知重构程序来完成的。在概述了失眠的概念模型（强调失调认知在慢性失眠的发展和维持中的中介作用）之后，介绍了失眠认知疗法的基本原理和一般原则，随后介绍了治疗程序和临床病例说明，以及实际的实施问题。未来的方向包括需要完善认知干预措施，并检查该治疗成分对多方面认知行为疗法整体疗效的独特贡献。

BACKGROUND & AIMS: BACKGROUND:Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia. METHODS:In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal. RESULTS:Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency. CONCLUSIONS:Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.

背景与目标： 背景：认知唤醒是睡眠障碍和失眠模型的核心，但关于认知唤醒是否与客观睡眠障碍和生理性过度兴奋有关的研究结果尚不明确。本研究探讨了健康睡眠者和失眠者的客观夜间觉醒和生理性高听觉指标与认知唤醒的相关性。
方法：总而言之，对52名成人（51.9％的女性; 18名失眠症，34名健康睡眠者）进行了两次通宵多导睡眠图（PSG）研究（适应基线夜晚）和一次多重睡眠潜伏期测试（MSLT）。评估基线抑郁症，并每晚记录入睡前的认知唤醒和躯体唤醒。多变量回归用于评估PSG睡眠参数与失眠，认知唤醒和躯体唤醒的关联。
结果：分析表明，夜间PSG的高夜间睡眠意识觉醒与长时间的睡眠潜伏期，较低的睡眠效率和较短的总睡眠时间有关。仅在一个晚上观察到夜间认知唤醒与睡眠发作后苏醒之间的关联。此外，更大的夜间认知唤醒与获得短暂睡眠和更长的MSLT睡眠潜伏期的可能性更大有关。失眠的诊断，抑郁和躯体唤醒与PSG睡眠参数或MSLT潜伏期无关。
结论：夜间增强的认知唤醒与夜间和白天的客观睡眠障碍和生理性高音指标有关。对于失眠患者，认知唤醒可能会导致24小时生理性兴奋。认知唤醒可能是严重或难以治疗的睡眠障碍的关键治疗目标。

BACKGROUND & AIMS: OBJECTIVE:To examine the distribution, consistency, and correlates of sleep time perceptions in primary insomnia sufferers and normal sleepers across settings (laboratory and home). METHODS:Fifty-two middle-aged and older insomnia sufferers and 49 matched normal sleepers underwent multiple nights of laboratory and home polysomnography (PSG) and provided concurrent subjective estimates of their sleep. Descriptive statistics, cluster analyses, and inferential tests were used to examine the nature of sleep time perceptions, identify subgroups with distinctive patterns such as perceptions, and explore factors that may contribute to these subgroups' distinctive sleep perceptions. RESULTS:Consistent with previous studies, the insomnia sufferers, as a group, showed a greater tendency to underestimate the time they slept than did the normal sleepers, but the accuracy of sleep time perceptions varied widely within each sample. Correlational analyses showed that study participants in each sample showed a moderate level of consistency in how accurately they estimated sleep time across nights. Subsequent cluster analyses conducted to identify subgroups with distinctive patterns of sleep time perceptions yielded four subgroups within the insomnia sample and three subgroups within the normal sleeper sample. Although the sleep setting significantly affected sleep perceptions for one insomnia subgroup, both laboratory and home objective-subjective sleep comparisons provided similar impressions regarding the relative accuracy of each subgroup's nocturnal sleep/wake perceptions. Finally, varying patterns of subgroup differences were noted across several common psychometric measures. CONCLUSIONS:The underestimation of sleep time is not a generic characteristic that separates all insomnia sufferers from normal sleepers. Sleep setting, personality traits, and perhaps constitutional factors appear to influence perceptions of sleep and wake time duration.

背景与目标： 目的：研究原发性失眠患者和正常睡眠者在不同环境（实验室和家庭）中的睡眠时间知觉分布，一致性和相关性。
方法：对52名中老年失眠患者和49名相匹配的正常睡眠者进行了多夜的实验室和家庭多导睡眠图（PSG）检查，并同时提供了他们的睡眠主观估计。描述性统计，聚类分析和推论测试用于检查睡眠时间知觉的性质，识别具有独特模式（例如知觉）的亚组，并探索可能有助于这些亚组独特的睡眠知觉的因素。
结果：与以前的研究一致，失眠症患者作为一个整体，比正常的睡眠者表现出低估其睡眠时间的趋势更大，但是在每个样本中，睡眠时间感知的准确性差异很大。相关分析表明，每个样本中的研究参与者在估计夜间睡眠时间的准确性上均表现出中等程度的一致性。随后进行的聚类分析确定了具有独特的睡眠时间感知模式的亚组，在失眠样本中产生了四个亚组，在正常睡眠者样本中产生了三个亚组。尽管睡眠设置显着影响了一个失眠亚组的睡眠感知，但实验室和家庭客观-主观睡眠比较均对每个亚组的夜间睡眠/觉醒感知的相对准确性提供了相似的印象。最后，在几种常见的心理测量方法中，注意到了亚组差异的变化模式。
结论：低估睡眠时间并不是将所有失眠症患者与正常睡眠者区分开的普遍特征。睡眠环境，人格特质，也许还有体质因素似乎会影响对睡眠和唤醒时间长短的看法。

BACKGROUND & AIMS: BACKGROUND:It has been shown that restless legs syndrome (RLS) in adults may be linked to abnormalities in iron stores. Whether reduced iron stores play a role in children is not clear. METHODS:We evaluated the status of iron stores and sleep in three teenagers who presented with severe sleep onset insomnia, subjective sleep latency exceeding 60 min and excessive daytime sleepiness. RESULTS:The three teenagers were found to have RLS and laboratory evaluation confirmed reduced body stores of iron with a low percent iron saturation (mean value 9.7%) and a low serum ferritin level (mean value 17 microg/l). None had marked anemia. The three patients were treated with oral iron for 4-5 months. As a group they had an increase in percent iron saturation (from a mean of 9.7 to 22.7%) and serum ferritin (from a mean of 17 to 27 microg/l) and a marked reduction of the symptoms of RLS, with mean subjective sleep latency decreasing from 143 to 23 min, sleep efficiency increasing from 75.7 to 84.0% and the number of periodic movements per hour of sleep decreasing from 20.5 to 10.5. INTERPRETATION:These findings support the hypothesis that abnormal iron stores or metabolism may result in RLS causing insomnia in teenagers. We recommend evaluation of iron status including serum iron, total iron binding capacity and ferritin levels in teenagers with chronic insomnia of unexplained origin even when anemia is mild or absent.

背景与目标： 背景：研究表明，成年人的不安腿综合征（RLS）可能与铁存储异常有关。减少铁存储是否在儿童中发挥作用尚不清楚。
方法：我们评估了三名青少年的铁存储和睡眠状况，这些青少年表现为严重的睡眠发作性失眠，主观睡眠潜伏期超过60分钟和白天过度嗜睡。
结果：发现这三名少年患有RLS，实验室评估证实铁的体内储备减少，铁饱和度低（平均值9.7％），血清铁蛋白水平低（平均值17 microg / l）。没有明显的贫血。这三例患者接受了口服铁剂治疗4-5个月。作为一个小组，他们的铁饱和度百分比（从9.7到22.7％）和血清铁蛋白（从17到27 microg / l的平均值）增加，并且RLS症状明显减轻，平均主观睡眠潜伏期从143分钟减少到23分钟，睡眠效率从75.7％增加到84.0％，每小时每小时的周期性运动次数从20.5减少到10.5。
解释：这些发现支持以下假设，即异常的铁存储或新陈代谢可能导致RLS导致青少年失眠。我们建议评估铁源的状态，包括血清铁，总铁结合能力和铁蛋白水平，这些铁源包括患有轻度或无贫血的原因不明的慢性失眠少年。

BACKGROUND & AIMS: In this study we examined well fixed brain biopsies of 9 sporadic CJD, 9 iatrogenic CJD cases, 2 hereditary CJD (Gly200Lys and Val203Iso), a case of vCJD and a case of fatal familial insomnia (FFI) from a new French family collected over the years at the Service de Neuropathologie, Hopital Neurologique, Lyon, France. Tubulovesicular structures (TVS) were found in every case including FFI and nvCJD. Thus, TVS, as we suggested previously are important pathologic structure which significance should be more extensively studied.

背景与目标： 在这项研究中，我们检查了9例散发性CJD，9例医源性CJD病例，2例遗传性CJD（Gly200Lys和Val203Iso），1例vCJD和1例致命法国家族性失眠（FFI）的固定脑活检。在法国里昂的Hopital Neurologique神经病学服务中心任职多年。在每种情况下都发现了肾小管状结构（TVS），包括FFI和n​​vCJD。因此，正如我们先前所建议的那样，TVS是重要的病理结构，其重要性应得到更广泛的研究。

BACKGROUND & AIMS: ABSTRACT:Zolpidem is an imidazopyridine nonbenzodiazepine hypnotic drug with a high affinity to the α1 subunit of the gamma amino butyric acid A receptor It is the first pharmacological option in the short-term management of sleep-onset insomnia. Initially considered a safer drug compared to benzodiazepines because of lower liability for abuse and dependence, recently, an increasing body of reports has questioned zolpidem's proneness to misuse. In this report, we describe a case of serious zolpidem abuse requiring pharmacological washout during hospitalization because of previous withdrawal seizures in a patient with chronic sleep-onset and maintenance insomnia.

背景与目标： 摘要：唑吡坦是一种对γ-氨基丁酸A受体的α1亚基具有高亲和力的咪唑并吡啶非苯并二氮杂类催眠药，它是短期治疗睡眠型失眠的第一个药理学选择。由于对滥用和依赖性的责任较低，最初被认为比苯二氮卓类药物更安全的药物，最近，越来越多的报道质疑唑吡坦是否容易滥用。在本报告中，我们描述了因长期睡眠发作和维持性失眠患者先前停药发作而需要在住院期间进行药理学冲洗的严重唑吡坦滥用病例。

BACKGROUND & AIMS: BACKGROUND:The majority of patients who seek help for insomnia do so in primary health care. Nurse-led group treatment in primary care based on cognitive behavioral therapy for insomnia (CBT-I) can lead to improvements in both day- and nighttime symptoms. This study aimed to explore patients' experiences of nurse-led group treatment for insomnia in primary health care. METHODS:Seventeen patients who had participated in the group treatment program were interviewed in five focus groups. Interview transcriptions were analyzed with qualitative content analysis. RESULTS:Four themes emerged that described patients' experiences of the group treatment program. Involvement and trust open the door for change: Motivation to engage in treatment arose from patients' own desire for change, from being together with others who shared or understood their struggles, and from feeling emotionally affirmed and trustful. Competence arising from deeper understanding: Patients obtained knowledge and made it their own, which enabled them to develop functional sleep habits and let go of sleep performance and worry. The ability to impact their insomnia increased patients' trust in their own efficacy and helped them persist in behavioral change. Struggling with vulnerability and failure: Treatment was tough, and patients could feel challenged by external circumstances. Moreover, they could distrust their own efficacy. Tailoring treatment to individual needs: Patients experienced different life circumstances and adapted the techniques to their needs and abilities by focusing on what felt right for them. CONCLUSIONS:Patients went through a process of motivation, change, and challenges. They experienced certain aspects of treatment as essential to changing behavior and achieving improvements. Examples included being in a group with others who shared similar experiences, gaining knowledge about sleep, keeping a sleep diary, and practicing the sleep restriction technique. The study provides insights into patients' struggles during treatment, both those related to external circumstances and those related to feelings of vulnerability and failure. It also highlights the importance of adapting treatment to patients' differing needs, underscoring the value of person-centered care.

背景与目标： 背景：大多数寻求失眠帮助的患者都是在初级卫生保健中寻求帮助的。基于失眠认知行为疗法（CBT-1）的初级保健中由护士主导的团体治疗可以改善白天和晚上的症状。本研究旨在探讨患者在初级卫生保健中以护士为主导的团体治疗失眠的经历。
方法：在五个焦点小组中采访了参加小组治疗方案的17名患者。访谈记录采用定性内容分析法进行分析。
结果：出现了四个主题，描述了患者在集体治疗计划中的经历。参与和信任为变革打开了大门：患者进行治疗的动机来自患者对变革的渴望，与共享或理解其斗争的其他人在一起以及对情感的肯定和信任。通过加深了解而产生的能力：患者获得了知识并掌握了自己的知识，这使他们能够养成机能性的睡眠习惯，并放开睡眠表现和烦恼。影响患者失眠的能力增加了患者对其自身疗效的信任，并帮助他们坚持了行为改变。在脆弱性和失败中挣扎：治疗很艰难，患者可能会受到外界环境的挑战。而且，他们可能不信任自己的功效。根据个人需求量身定制治疗方案：患者会经历不同的生活环境，并通过专注于自己的感觉来使技术适应他们的需求和能力。
结论：患者经历了动机，变化和挑战的过程。他们经历了某些治疗方面，这些方面对于改变行为和改善病情至关重要。例子包括与有类似经历的其他人在一起，获得有关睡眠的知识，记录睡眠日记，并练习睡眠限制技术。该研究为患者在治疗过程中的挣扎提供了见识，包括与外部环境有关的以及与脆弱和失败感相关的见解。它还强调了根据患者的不同需求调整治疗的重要性，强调了以人为中心的护理的价值。

BACKGROUND & AIMS: BACKGROUND:The Australian Government Department of Veterans' Affairs (DVA) Veterans' Medicines Advice and Therapeutics Education Services (Veterans' MATES) programme conducted two intervention (March 2009, follow-up intervention June 2012) both of which aimed to reduce hypnotic use among Australian veterans. We evaluated the effectiveness of the interventions, and estimated the associated health consequences. METHODS:Both interventions targeted veterans who had been dispensed hypnotics prior to the intervention. Patient-specific prescriber feedback containing patient details and the volume of hypnotics dispensed, along with tailored educational information, was mailed to general practitioners. Veterans, pharmacists and directors of care in residential aged care facilities were mailed tailored educational information. Interrupted time-series and segmented regression modelling were used to determine the effect of the two interventions on the rate of hypnotics dispensing. The cumulative patient-months of hypnotic treatment avoided as a result of the interventions was calculated. We estimated improvements in health consequences of as a result of hypnotic treatment avoided based on the results of cohort studies in the same population identifying the association between hypnotic and sedative use on the outcomes of falls, and confusion. RESULTS:After the first Veterans' MATES intervention in March 2009, hypnotic use declined by 0.2% each month, when compared to the baseline level (p = 0.006). The intervention effect was attenuated after one year, and use of hypnotics was found to increase by 0.2% per month after March 2010. Following the second intervention in June 2012, there was a further significant decline in use of 0.18% each month over the 12 months of follow up (p = 0.049). The cumulative effect of both interventions resulted in 20,850 fewer patient-months of treatment with hypnotics. This cumulative reduction in hypnotic use was estimated to lead to a minimum of 1 fewer hospital admissions for acute confusion and 7 fewer hospital admissions due to falls. CONCLUSIONS:The Veterans' MATES insomnia interventions which involved multiple stakeholders were effective in reducing hypnotic use among older Australians. Repetition of key messages led to sustained practice change.

背景与目标： 背景：澳大利亚政府退伍军人事务部（DVA）退伍军人医学咨询和治疗教育服务（Veterans'MATES）计划实施了两项干预措施（2009年3月，2012年6月进行了后续干预），均旨在减少使用催眠药的人澳大利亚退伍军人。我们评估了干预措施的有效性，并估计了相关的健康后果。
方法：两种干预措施均针对在干预之前已分配催眠药的退伍军人。包含患者详细信息和分配的催眠药的量以及针对性的教育信息的针对患者的处方开具反馈已邮寄给全科医生。退伍军人，药剂师和住宅老年护理机构中的护理主管都收到了量身定制的教育信息。中断时间序列和分段回归模型用于确定两种干预措施对催眠药分配速度的影响。计算了由于干预而避免的累计催眠治疗患者月数。根据同一人群的队列研究结果，我们确定了使用催眠治疗可避免因服用催眠药和镇静剂对跌倒的后果和精神错乱之间的联系，从而避免因服用催眠药而对健康产生的影响。
结果：在2009年3月进行第一次退伍军人的MATES干预后，与基线水平相比，催眠药的使用每月下降了0.2％（p = 0.006）。一年后干预作用减弱，发现催眠药的使用在2010年3月之后每月增加0.2％。在2012年6月进行第二次干预之后，在12个月中每月进一步减少0.18％的使用个月的随访时间（p = 0.049）。两种干预措施的累积效果使使用催眠药的患者治疗时间减少了20,850个月。据估计，这种催眠药使用量的累积减少导致因急性精神错乱住院的病人最少减少1次，而因摔倒而住院的人数最少减少7次。
结论：涉及多个利益相关者的退伍军人队的MATES失眠干预措施有效地减少了澳大利亚老年人的催眠使用。关键信息的重复导致了持续的实践改变。

BACKGROUND & AIMS: BACKGROUND:Despite the prevalence of comorbid late-life treatmentresistant depression (LLTRD) and insomnia in older adults, there is a gap in the literature describing patient factors, such as patients' beliefs about their illnesses and preferences for treatment, that can facilitate recovery. Therefore, we explored the perceptions and treatment preferences of older veterans with LLTRD and insomnia. METHODS:Semi-structured interviews were completed with 11 older veterans. A thematic analysis of the interviews was conducted. RESULTS:Four main themes were identified: 1. Insomnia and medical problems were considered to be significant contributors to depression, which was defined by low mood and anhedonia; 2. "Overthinking" was thought to be a cause of insomnia; 3. Participants' preference for psychotherapy was driven by their past experiences with therapy; and 4. Participants viewed patient education as a facilitator for compliance. CONCLUSIONS:Older veterans with LLTRD and insomnia have a preference for behavioral interventions. However, they lack knowledge about available treatment options, such as behavioral interventions for sleep that can improve both their sleep and mood while being a good fit with their illness narratives, such as "overthinking." There is a need for patient education, which should be offered early and often during treatment.

背景与目标： 背景：尽管在老年人中普遍存在晚期难治性合并抑郁症（LLTRD）和失眠症，但文献中仍存在描述患者因素的空白，例如患者对疾病的看法和对治疗的偏爱，这些因素有助于康复。因此，我们探讨了患有LLTRD和失眠的老年退伍军人的观念和治疗偏好。
方法：半结构式访谈完成了11位老年退伍军人。对访谈进行了专题分析。
结果：确定了四个主要主题：1.失眠和医学问题被认为是抑郁症的主要诱因，抑郁症的定义为情绪低落和快感不足； 2.“过度思考”被认为是失眠的原因； 3.参与者对心理治疗的偏爱是由他们过去的治疗经验所驱动的； 4.参加者认为对患者的教育是促进依从性的方法。
结论：患有LLTRD和失眠的老年退伍军人倾向于行为干预。但是，他们缺乏有关可用治疗方案的知识，例如对睡眠的行为干预，可以改善他们的睡眠和情绪，同时又很适合其病情叙述，例如“过度思考”。需要对患者进行教育，应该在治疗过程中及早提供这种教育。