研究目的：睡眠遲惰（sleep inertia）指的是剛由睡眠中醒來的一種現象，在這段轉換期間內，個體的警覺力較低、心智較為遲緩，認知和行為表現都較差。過去針對睡眠遲惰的研究顯示，睡眠遲惰是從一個較低生理激發的狀態到較高生理激發的漸進式轉換過渡階段。若睡眠遲惰是與較低的生理激發狀態有關，則若能提高個體的激發狀態，應能減少睡眠遲惰的負面影響。從過去的文獻中可發現，快節奏的音樂可以提高個體的生理激發。因此，本研究針對音樂的節奏快慢做操弄，探討生理激發狀態在睡眠遲惰所扮演的角色，比較不同快慢節奏的音樂刺激對於睡眠遲惰效果的影響。 方法：12名年齡介於18到31歲之間的受試者參與此研究。受試者在20分鐘小睡被喚醒後，分次接受快節奏音樂、慢節奏音樂、以及無音樂控制情境等三種情境安排。睡醒後的實驗期間為1小時，受試者每10分鐘被要求進行加法作業及填寫卡羅連斯加睡意量表（Karolinska Sleepiness Scale）、視覺類比量表（visual analog scales）、以及情緒評估等主觀量表，總計六次。同時，他們的腦電波（electroencephalogram）、心率變異率（heart rate variability）、膚電反應（skin conductance responses）、指溫等生理反應亦被記錄。 結果：受試者在認知表現或主觀評量上的確顯現出睡眠遲惰的效果，其加法作業的完成題數隨著時間增加，而主觀睡意則隨著時間減少。快節奏音樂情境比慢節奏音樂情境有顯著較高的主觀激發程度，並有較清醒的評量。在生理測量部分，受試者在快節奏音樂情境中有顯著較高的非特定刺激引起之膚電反應（Non-specific skin conductance responses）和腦電波較多beta波的趨勢。然而，儘管受試者的主觀評量會受到音樂刺激的影響而有不同，其認知表現並沒有出現類似的效果。 結論：本研究發現藉由音樂提高激發狀態，可使主觀睡意評量降低，但認知表現並不受到影響。此分離的現象顯示睡眠遲惰的消散不能以單一的生理激發狀態來解釋，而必須考慮多種歷程機制同時運作的可能性。 / Objective：Sleep inertia (SI) is a transitional state occurring immediately after awakening from sleep that are associated with sleepiness, decreased alertness and decrement in cognitive performance. It has been suggested that SI may be due to a decline in arousal level. Therefore, it was hypothesized that factors likely increasing arousal would reduce the effects of SI. Previous studies showed that fast-tempo music may enhance the level of arousal. The present study was conducted to clarify the role of arousal in SI by exposure to music with different tempos. Methods：Twelve healthy young adults, aged 18 to 31 years, participated in the study. All subjects went through three conditions: a fast-tempo music, a slow-tempo music, and a control (no music) conditions. Music stimuli were applied to subjects awaked from a 20-mins nap, and the subjects were given an addition task and asked to rate their level of subjective sleepiness and arousal on the Karolinska Sleepiness Scale (KSS), visual analog scales (VAS) and emotional rating scales 6 times over an hour. During the test period, their physiological arousal state was recorded, including electroencephalogram (EEG), heart rate variability (HRV), skin conductance responses (SCR), finger temperature. Results：The effects of SI on cognitive throughput and subjective ratings were evident. Their performance on the addition task increased and sleepiness decreased over time. Subjective sleepiness was significantly reduced and physiological arousal level measured by non-specific skin conductance responses (NS-SCRs) and EEG beta power were elevated when the participants were exposed to fast-tempo music. However, cognitive performance was not influenced by music exposure. Conclusion：The present findings suggest that increased arousal level during SI by manipulating music stimuli may decrease subjective sleepiness but have no impact on cognitive performance. This dissociative effect suggests that the dissipation of sleep inertia may not be a function of a general arousal level. Rather, there may be multiple processes that are responsible for different aspects of SI.

研究目的：過去的心理生理學研究顯示，個體在壓抑生氣與表達生氣情緒時，分別對於情緒調節和生理反應上有著不同的作用機制。本研究試圖以Engebretson等人（1989）提出的「適配假說」（Matching Hypothesis），進一步延伸探討其對於後續睡眠的影響，並預期在引起受試者的生氣情緒後，若其當下所採用的生氣表達方式與自身所慣用的方式是一致的，則能有效地降低個體睡前的生理激發狀態，促使其恢復到先前的水準，因此對於個體後續睡眠的負面影響也會較小。 方法：本研究共收案35人(男12人，女23人)，對象為年齡介於20到35歲之間，身心健康的正常睡眠者。研究者先透過短式華人敵意量表，將受試者分類為高壓抑敵意特質組(HS)18人、高表達敵意特質組(HE)17人，之後再將其隨機分派到壓抑生氣(AI)或表達生氣(AO)其中一種實驗情境。實驗中，係透過高難度的認知作業來引發受試者的壓力和挫敗感，再於過程中不停地打斷其作答狀態來造成其煩擾，以達到生氣情緒的誘發；隨後再經由有/無給予機會讓受試者表達心情並對主試者(激怒者)進行評價，來達到表達/壓抑生氣的實驗操弄，之後即請其入睡。期間持續以Biopac MP150生理儀器來測量受試者的心跳速率(HR)、收縮壓(SBP)、舒張壓(DBP)和膚電反應(SCR)，以了解其於入睡前的生理激發與恢復狀態；後續以多頻道睡眠記錄儀（polysomnography, PSG）來進行夜間睡眠之記錄，並以受試者的自評睡眠狀況作為主觀睡眠品質的分析指標。 研究結果：在誘發生氣情緒後，不論是在表達生氣或壓抑生氣的情境下，HE都比HS有顯著更高的DBP上升反應。在恢復期期間，HE的DBP則有低於HS的傾向；AO比AI有更多的DBP恢復程度，以及較短的SCR恢復時間。而在適配情境下，受試者後續的HR恢復時間較短，且DBP的下降程度較多，此也支持了適配假說的觀點；然而，不論適配與否，對於後續的睡眠相關參數並無顯著的影響，此未支持本研究假設。再以2(特質)x 2(情境)之二因子獨立樣本變異數分析比較各組在睡眠結構上的差異，結果顯示階段二睡眠以及慢波睡眠的比例，皆有來自特質的主要效果；其中HS的階段二睡眠時間比例高於HE，HE的慢波睡眠時間比例則高於HS。另外，AO的慢波睡眠時間比例高於AI──顯示比起壓抑生氣，表達生氣的因應方式對於深睡期的增加可能較具正向的影響。最後，研究發現睡前SBP、DBP的上升皆和主觀入睡耗時的增加呈顯著正相關；PSG的檢查結果亦顯示，入睡期HR、SCR、SBP的上升和階段二睡眠潛時的增加呈顯著正相關；此外，當SCR的恢復時間越長，階段二睡眠潛時越長，顯示個體睡前較高的生理激發狀態和較慢的恢復速率，對於主客觀睡眠品質皆具有負面的影響。 結論：在經驗生氣情緒時，表達生氣相對而言是對於生理恢復狀態較為有利的因應方式；然而，「特質」不僅可能影響著生氣情緒當下的生理激起狀態，且對於後續的生理恢復亦具有一定之影響力。本研究支持了適配假說的觀點：當採用的生氣表達方式與自身所慣用的方式一致時，最能有效地降低心血管反應；然而，再去檢驗適配假說和後續睡眠品質之間的關係，並未發現符合預期的結果，故若欲以適配假說來預測後續較佳的睡眠品質，仍須更多相關的研究加以支持和驗證，且可能尚須納入其他重要變項加以探討，例如個人的認知風格、內在情緒調節策略等。最後，本研究結果再度彰顯了睡前的生理激發和恢復狀態對於後續睡眠歷程的影響力；而生理激發狀態在情緒、因應行為和睡眠間之關係所扮演的角色，也為急性失眠的病因機制提供了一種可能的註解。 / Introduction：From past studies it is known that anger suppression and anger expression may play different roles in emotion regulation and in psychophysiological response. Engebretson and his colleagues (1989) had proposed ‘Matching Hypothesis’-- that is, if one used his/her preferred mode of anger expression style in response to the instigation, then his/her cardiovascular reactivity (CVR) would be less elevated and would have a faster recovery rate of CVR than those who were engage in a manner of anger expression that was inconsistent with their preferred mode. To do a further study, we intend to know what would bring on in the following sleep if we used the two different anger expression style during the pre-sleep period. Besides, in according to Matching Hypothesis, we predict that if one expressed his/her anger in a preferred way, then this ‘matching’ state would make one’s physiological arousal effectively declined and would help it back to the baseline level more quickly; therefore, it would have less negative effect on the following sleep, and vice versa. Method：35 healthy individuals who has psychometric characteristic of high hostility were examined. All subjects’ preferred style of anger expression-- highly suppressive (HS) or highly expressive (HE), had been assessed by a self-report questionnaire. After the anger instigation, subjects were randomly assigned to two experimental conditions: anger in (AI) or anger out (AO), and then went to sleep. Biopac instrument and software were used to measure heart rate (HR), blood pressure (BP) and skin conductance response (SCR). Besides, polysomnography (PSG) was used to record the nocturnal sleep. In addition, the subjects were asked to fill out the self-report questionnaires next morning, as a measurement of subjective sleep quality. Finally, statistic analyzed the influence of two variables (trait and condition) on the physical arousal level, recovery rate and sleep quality. Results：HE showed higher DBP elevation than HS, both in the two conditions. During the recovery phase, there was an inclination that HE showed lower DBP than HS; AO showed a higher DBP recovery level, and a shorter SCR recovery time, comparing to AI. Subjects in the matching state showed a shorter HR recovery time, and much DBP decline; however, no matter in the matching state or not, there was no difference in the nocturnal sleep quality. To view the sleep architecture, HS showed higher percentage of stage 2 sleep than HE, and HE showed higher slow-wave sleep percentage than HS. On the other hand, AO showed higher slow-wave sleep percentage than AI, suggesting that expressing anger seems to be much helpful for the promotion of slow-wave sleep. Finally, the findings demonstrated that before sleep, the elevation of SBP and DBP showed positive correlations with longer subjective sleep onset latency. Besides, the elevation of HR, SCR and SBP was positively correlated with the longer onset latency of stage 2 sleep. Furthermore, longer SCR recovery time accompanied longer onset latency of stage 2, indicating that both high arousal state and low recovery rate brought negative effects on the following sleep. Conclusions：The CVR results generally were consistent with Matching Hypothesis. However, the findings indicated that the matching/non-matching state couldn’t be merely used to predict the sleep quality. Therefore, there is still a need to do more research to figure it out. In addition, variables such as personal cognitive style and emotional regulation strategy, should be bring into the future studies. In conclusion, the findings pointed out that the physical arousal state during the pre-sleep period will impact on the following sleep process significantly, and it plays a important role in the relationships between emotion, coping behavior and sleep.

研究目的：失眠已是臨床上常見的健康抱怨之一，而近年來在探討原發性失眠的病因理論上，又以失眠患者的過度激發（hyperarousal）有較多的實徵研究支持。主要的理論之一為Perlis等人提出的「失眠神經認知模式」，該模式認為失眠患者的睡眠問題乃肇因於其在睡眠時內在的認知運作仍處於過度活躍狀態。後續相關研究透過腦波頻譜分析發現，原發性失眠患者不論在靠近入睡開始或NREM睡眠，都較一般正常睡眠者有增加的高頻腦波活動與減少的低頻腦波活動，顯示失眠患者確實有較高的生理激發狀態與較低的睡眠恆定趨力。而臨床上，失眠患者最常見的主觀抱怨為入睡困難，故本研究希望透過原發性失眠患者在睡眠中的腦波頻譜分析，以探討失眠患者在入睡歷程的生理激發狀態與睡眠恆定趨力的變化，並進一步探討失眠患者睡前主觀激發狀態感受與客觀生理激發測量之相關性。 研究方法：本研究的原發性失眠組共30人（男10人，女20人，平均年齡為36.7歲），正常睡眠者（控制組）共25人（男8人，女17人，平均年齡為34.8歲）。參與者需至睡眠實驗室進行一晚的多頻道睡眠檢查（PSG），以作為睡眠相關呼吸疾患與睡眠相關運動疾患之篩檢，並以入睡前5分鐘至入睡後15分鐘（共20分鐘）所記錄之腦電波（EEG）作為後續腦波頻譜分析之用。另外，參與者須在睡前填寫睡前激發量表（PSAS），以評估參與者在睡前的主觀激發狀態感受。 研究結果：在睡前主觀激發狀態評估中，原發性失眠患者不論在生理激發或認知激發主觀感受上，皆顯著高於一般正常睡眠者(F = 23.950，p < .001；F = 64.235，p < .001)。在PSG記錄的睡眠相關參數上，則顯示失眠患者有較多的入睡後醒來總時數(F = 5.510，p = .023)、較少的階段二睡眠時間與比例(F = 7.088，p = .010；F = 32.616，p < .001)、較少的REM睡眠比例(F = 4.810，p = .033)，以及較差的睡眠效率(F = 8.685，p = .005)。在入睡歷程的腦波頻譜分析上，結果顯示失眠患者在睡醒的過渡期有較高的Alpha波功率，在進到睡眠後則有較低的Delta波功率，並且在整個入睡歷程中則是有較高的Theta波功率與Beta波功率。進一步比較兩組在入睡歷程腦波頻譜波段的上升與下降速度，結果顯示失眠患者在入睡歷程中，不論是睡眠恆定趨力上升的速度或生理激發下降的速度，皆顯著較一般正常睡眠者慢。另外，主觀認知激發狀態感受與入睡後的Delta波呈現顯著正相關；而與Theta波的相關上，則主要在入睡過渡階段有顯著正相關；Alpha波則僅與入睡歷程最後階段有顯著負相關；在與Beta波相關上，則從入睡過渡階段到入睡後皆有顯著負相關。主觀生理激發狀態感受則僅有與入睡過渡階段的Theta波有顯著正相關。 結論：本研究發現原發性失眠患者在入睡歷程中，不論在睡眠恆定趨力的上升速度或生理激發的下降速度上，皆明顯較正常睡眠者慢，雖生理激發狀態仍會隨著時間而有所降低，但卻仍維持較一般正常睡眠者高；睡眠趨力雖亦會有所增加，卻較一般正常睡眠者難以發揮較佳的作用，而可能造成失眠患者在入睡歷程中需花費更長的時間才能入睡，且進入睡眠後，仍維持較高的生理激發狀態與睡眠趨力發揮較差，進而可能導致失眠患者較淺眠或難以維持睡眠等問題。 / Introduction：Insomnia is a common healthy complain. The neurocognitive perspective of hyperarousal model of insomnia, as proposed by Perlis(1997), hypothesized that the sleep difficulties in insomniacs may result from enhanced information processing around sleep onset and during sleep. Supporting evidences were primarily from the findings that insomnia patients have increased high frequency EEG activity and decreased low frequency EEG activity during sleep, indicating insomniacs in general have higher physical arousal and lower sleep homeostasis. This study further aims to explore arousal level and sleep homeostasis during the period of sleep onset by comparing the level and change of EEG spectrum in primary insomnia patients and normal control subjects during the process of sleep onset. Methods：30 patients with primary insomnia (10 men, 20women, mean age of 36.7years) and 25 normal sleepers (8 men, 17women, mean age of 34.8years) underwent one night of PSG recording in a sleep laboratory to screening sleep-related breathing disorders and sleep-related movement disorders. They also completed the Pre-sleep Arousal Scale (PSAS) before bedtime. EEG spectrum analyses were conducted for the EEG data collected during the 5 minutes prior to sleep onset and the 15 minutes after. Results：Subjective ratings of both pre-sleep cognitive and somatic arousal were significantly higher in insomnia group (F = 23.950, p < .001; F = 64.235, p < .001) than control group. More WASO (F = 5.510, p = .023), less time and percentage of stage 2 sleep (F = 7.088, p = .010; F = 32.616, p < .001), less percentage of REM sleep (F = 4.810, p = .033), and poor sleep efficiency (F = 8.685, p = .005) were showed in PSG. The EEG spectrum during sleep-onset period showed that insomniacs had higher alpha power in the sleep-wake transition, lower delta power after falling asleep, and higher theta and beta power during sleep-onset period. In terms of the slope of EEG specrtrum change during the period of sleep onset, insomniacs had slower change than normal sleepers in increasing of sleep homeostasis and decreasing of physical arousal. In addition, the correlations between PSAS score and EEG power, cognitive arousal and delta power after falling asleep and theta power in sleep-onset process showed significant positive correlation. Alpha power in the later part of sleep-onset period and beta power around sleep-wake trainsition, on the other hand, showed negative correlations with cognitive arousal. Physcial arousal only showed positive correlation to theta power in sleep-wake trainsition. Conclusions：Patients with primary insomnia showed significantly less and slower increase in sleep homeostatic drive as well as less and slower decrease in EEG arousal during sleep-onset period. Although EEG arousal did showed gradually decreased by time, it still maintianed higher than normal sleepers. Sleep homeostasis did also increase, but may be interfered by the hyperarousal. This may explain the complaints in insomnia patients of difficulty falling asleep, difficulty maintaining sleep, and light sleep.