Reporting Status or Progress

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Homeostatic System
Sleep vs. Wake/Arousal
Circadian System
Arousal System
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Two-process Model of Sleep Regulation

• ????(Homeostatic System Process S)
• ????/????(Circadian System Process C)

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• Adenosine?????????????

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• Suprachiasmatic nucleus (SCN)
• Dorsomedial hypothalamus (DHM)

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????????20 hours/day? Core body
temperature Melatonin rhythms 24 hrs 15 mins
(Czeisler, 2000)
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????????(Forced desynchrony protocol)
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?? v.s. ????

• ????
• ???Melanopsin(??????) in ganglion cells
• Retinothalamic tract
• ???SCN(??????)
• ?????????????
• PRC of light on phase shifting
• Short wavelengths (470nm blue light) are most
  effective.

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SCN Lesion Studies
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• Activate thalamic relay neurons reticular
  nucleus of the thalamus
• Project to lateral hypothalamic area BF, and
  throughout the cerebral cortex

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Psychological/BehavioralFacotrs
NeurophysiologicalSystems
BehavioralPractices
Homeostatic System
Sleep Cognition
Sleep vs. Wake/Arousal
Circadian System
EmotionalArousal
Arousal System
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Cognitive Model of Insomnia (Harvey, 2002)
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3P Model of the Development of Insomnia

• Predisposing Factor
• Individual characteristic to set the stage for
  the development of insomnia
• Precipitating Factor
• The event that triggers the onset of insomnia
• Perpetuating Factor
• The factors that maintain the continuation of
  insomnia

(Spielman AJ et al., 1986)
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Light Therapy for DSPS
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• ???????(polysomnography,PSG)

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• ?????(CPAP)

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Components of CBT for Insomnia

• Education Component
• Understand sleep mechanisms
• Understand sleep pathologies
• Sleep hygiene practices
• Behavioral Component
• Sleep scheduling stimulus control sleep
  restriction
• Relaxation training
• Adjusting circadian clock
• Medication tapering
• Cognitive Component
• Cognitive restructuring
• Paradoxical intension
• Stress management

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CBT vs. Hypnotic for Sleep Maintenance Insomnia
in Elderly
Morin et al. JAMA 1999 281991-999.
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CBT vs. Hypnotic for Sleep-Onset Insomnia
(Jacobs, G.D., et al. Ach Intern Medicine
2004164 1888-1896)
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Have a Nice Sleep!!