BACKGROUND: Sleep problems affect people of all ages, race, gender, and socioeconomic classifications. Undiagnosed sleep disorders significantly and adversely impact a person’s level of academic achievement, job performance, and subsequently, socioeconomic status. Undiagnosed sleep disorders also negatively impact both direct and indirect costs for employers, the national government, and the general public. Sleepiness has significant implications on quality of life by impacting occupational performance, driving ability, cognition, memory, and overall health. The purpose of this study is to describe the prevalence of daytime sleepiness, as well as other quantitative predictors of sleep continuity and quality. METHODS: Population data from the CDC program in fatigue surveillance were used for this secondary analysis seeking to characterize sleep quality and continuity variables. Each participant underwent a standard nocturnal polysomnography and a standard multiple sleep latency test (MSLT) on the subsequent day. Frequency and chi-square tests were used to describe the sample. One-Way Analysis of Variance (ANOVA) was used to compare sleep related variables of groups with sleep latencies of <5 >minutes, 5-10 minutes, and >10 minutes. Bivariate and multivariate logistic regression was used to examine the association of the sleep variables with sleep latency time. RESULTS: The mean (SD) sleep latency of the sample was 8.8 (4.9) minutes. Twenty-four individuals had ≥1 SOREM, and approximately 50% of participants (n = 100) met clinical criteria for a sleep disorder. Individuals with shorter sleep latencies, compared to those with longer latencies reported higher levels of subjective sleepiness, had higher sleep efficiency percentages, and longer sleep times. The Epworth Sleepiness Scale, sleep efficiency percentage, total sleep time, the presence of a sleep disorder, and limb movement index were positively associated with a mean sleep latency of <5 >minutes. CONCLUSIONS: The presence of a significant percentage of sleep disorders within our study sample validate prior suggestions that such disorders remain unrecognized, undiagnosed, and untreated. In addition, our findings confirm questionnaire-based surveys that suggest a significant number of the population is excessively sleepy, or hypersomnolent. Therefore, the high prevalence of sleep disorders and the negative public health effects of daytime sleepiness demand attention. Further studies are now required to better quantify levels daytime sleepiness, within a population based sample, to better understand their impact upon morbidity and mortality. This will not only expand on our current understanding of daytime sleepiness, but it will also raise awareness surrounding its significance and relation to public health.

研究目的：再評估策略在清醒時是廣為使用且能夠有效降低負向情緒的方法之一。若個人在睡前使用，應預期也能降低情緒而促進入睡。然而，調查研究卻發現睡前使用再評估策略的習慣與入睡歷程未有預期的正向關連。研究者回顧發現，再評估策略可能包含了各種不同性質的次分類，高控制性的再評估策略可能會導致過度激發狀態，影響入睡。本研究目的即在於比較控制性高（改變對當下情境的詮釋）與低（接受）的再評估策略，讓兩組受試者在使用不同策略後嘗試入睡，並詢問其入睡歷程下的主觀入睡經驗。預期高控制再評估策略會導致受試者較高的認知激發狀態，而在階段二睡眠喚醒後有較多人自陳仍有思考活動，較少人自認已經睡著，以釐清入睡前使用不同次分類再評估策略所造成的控制性認知活動，可能對入睡歷程帶來的影響。 研究方法：本研究共招募26名受試者，並隨機分派至接受組（13人，7位男性，6位女性，平均年齡23.6歲）與對當下情境詮釋組（13人，男性6位，女性7位，平均年齡24.9歲）。受試者皆須依序經過中性情境以及情緒誘發情境兩個夜晚。在情緒誘發情境下，主試者會對其表現給予負向回饋以引發情緒，接著依不同組別要求受試者在睡前使用不同再評估策略來調適情緒，隨後嘗試入睡。同時，主試者會在睡前測量受試者的認知激發狀態，並於進入階段二睡眠後，即時喚醒詢問其入睡歷程意識經驗，包含主觀入睡知覺（自評睡著與否）、思考活動（是否仍有思考）等。 研究結果：本研究結果顯示，睡前使用高控制性策略，的確造成較高的入睡前控制活動，形成較高認知激發狀態，影響入睡歷程。在階段二睡眠喚醒後，使用較高控制性策略的組別也較另一組有較高比例報告仍在思考，覺得自己尚未睡著，並低估自己有睡著的時間。 結論：本研究探討控制性不同的再評估策略對主客觀入睡歷程的影響。研究結果支持高控制性策略會造成認知激發狀態，並使受試者在客觀定義入睡喚醒後，仍有較多的思考活動與較少的入睡知覺，同時較低估自己有睡著的時間，顯示入睡前較高的控制性認知活動，的確可能影響受試者的入睡歷程。這支持了先前研究對再評估策略並非單一構念的假設，未來研究再評估策略時，須考慮其次分類才能有全面性的了解。最後，對照過去研究，睡前使用再評估策略的習慣與入睡歷程未有預期的正向關連，可能是與未考慮控制性有關。 / Objective: Reappraisal was found to be effective to decrease negative emotion, thus is considered to be an useful strategy for emotion regulation, because it was (Gross, 1998; 2001). Since negative emotion is associated with sleep disruption, reappraisal is supposed to facilitate sleep-onset. Nevertheless, previous study did not support this point of view (Harvey, 2001; Ree et al., 2005). There was a negative association reported between use of reappraisal and sleep quality in insomnia patients. Researchers have identified different types of reappraisal strategies (McRae et al., 2011) with different levels of controlling cognitive activity. The unexpected association between reappraisal and sleep might be due to the impact of increased level of cognitive activity associated with reappraisal. This study aims to compare the effects of two types of reappraisal strategies, change thought (high cognitive activity) and accept feelings (low cognitive activity), on sleep onset process. Methods: Twenty six participants were recruited for this study, randomized to one of two groups (Acceptance group: N=13, average age=23.6 years; Change group: N=13, average age=24.9 years). Each participant will go through two nights of sleep recording at the sleep lab. The first night was baseline condition; the second night was experimental condition. After the emotion induction, the experimenter instructed the participants to use different reappraisal strategies to regulate their emotion, and then asked them to try to fall sleep in the experimental night. The experimenter woke up participants after 5-min after the start of stage 2 sleep, and asked their subjective experience right before waking up, including sleep perception (sleep or not) and thinking experience. Results: As expected, the Change group had higher controlling cognitive activity and arousal level than the Acceptance group before going to bed. Then, after waking up participants on stable stage 2 sleep, the Change group had higher thinking experience, lower sleep perception and underestimated sleep time than Acceptance group. Conclusions: The findings of this research show that high controlling activity reappraisal could have a negative impact on sleep-onset period than low controlling activity reappraisal. The result supports our hypothesis that controlling cognitive activity can increase pre-sleep arousal level that further increase cognitive activity during sleep-onset period and decrease the perception of sleep.

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.

過去研究顯示負向情緒會干擾夜間睡眠，預期可有效降低負向情緒的情緒調節策略應有助於睡眠，然而，認知再評估策略對睡眠的影響卻未有一致的研究結果，此可能受限於過去研究多以問卷測量認知再評估策略的使用偏好，卻未測量個體使用策略的能力，亦即認知再評估策略的調節效果。本研究透過實驗室典範測量認知再評估能力，主要探討個體使用認知再評估策略的能力是否會影響個體於夜間情緒調節的效果，以及再評估策略於睡前之適用性。本研究受試者共24位，包含11名男性與13名女性，平均年齡為22歲。受試者皆依序經歷引發和調節負向情緒的實驗情境與中性情境兩個夜晚，並以主觀問卷與客觀生理反應測量受試者使用認知再評估策略調節情緒的表現，及對其後續睡眠的影響，在兩晚作業結束後，受試者會回到實驗室進行認知再評估能力測量作業。研究結果發現，認知再評估能力佳者於實驗晚的情緒調節表現較佳，在能力指標中，正負向與憤怒感調節佳者，其睡前生理激發度增加量較低、入睡前高頻腦波相對功率較低，且較不會高估入睡耗時；此外，運用再評估策略會增加較高情緒控制感者，入睡後高頻腦波相對功率較低，且實驗晚所增加的入睡耗時較低。整體來說，負向情緒會干擾後續睡眠，於正負向指標上調節能力佳者較可減少其主觀失眠困擾度，且使用再評估策略後有較高情緒控制感者，較可彈性的運用再評估策略。 / Negative emotion has been showed to interfere with sleep, therefore effective emotion regulation to reduce negative emotion prior to sleep could be beneficial for sleep. Cognitive reappraisal is generally considered to be an effective and adaptive emotion-regulation strategy, but previous studies had inconsistent findings about the impact of reappraisal on sleep. A study has even found that insomnia patients had a higher frequency to use reappraisal in comparison to good sleepers. However, previous studies used self-report measure of an individual's tendency to use reappraisal. It has been shown that the frequency of using reappraisal did not correlate with the ability to use reappraisal as measured by reduction of stress reactivity after standard laboratory challenge. The present study examined the hypothesis that the impact of pre-sleep reappraisal on sleep onset process depends on individual's cognitive reappraisal ability (CRA). Twenty-four normal sleepers were recruited (male:11, female:13, average age: 22 years). Participants came to sleep laboratory for two experimental nights and one daytime reappraisal ability evaluation. For the two experimental nights, participants did a cognitive task and got two different feedbacks for the two conditions: either a neutral feedback (baseline condition night) or a negative feedback (experimental condition night). They were instructed to use cognitive reappraisal strategy to reduce negative emotion after getting negative feedback. The change of subjective emotion ratings and physiological reaction were measured during the presleep task. Polysomnographic recording and subjective ratings of sleep onset experience was conducted for the sleep onset process analysis. During the daytime session, the ability of the participants to use reappraisal was measured with physiological reactivity to a standard laboratory challenge with anger-inducing films. The results showed that, at experimental night, participants with high CRA in reducing emotion valence exhibited better emotion regulation outcomes, less presleep somatic arousal increments, lower beta power before falling asleep, and less overestimation of their sleep onset latency (SOL). Besides, participants with high CRA in reducing dominance of emotion exhibited shorter emotion regulation time, lower beta power after falling asleep, and lesser SOL increments. This finding is consistent with the hypothesis that reappraisal ability would determined whether cognitive reappraisal strategy is adaptive for presleep emotion regulation; those individuals with better CRA in reducing dominance of emotion might have more flexibility in applying reappraisal strategy.

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