政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/151512

政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/151512

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Title:	以每日情緒及睡眠紀錄探討安眠藥物渴想的預測因子 The Predictability of Hypnotic Craving Based on Emotion and Sleep with Daily Measures
Authors:	吳宇婷 Wu, Yu-Ting
Contributors:	楊建銘 Yang, Chien-Ming 吳宇婷 Wu, Yu-Ting
Keywords:	安眠藥渴想每日測量 Hypnotics Craving Daily measures
Date:	2024
Issue Date:	2024-06-03 11:45:36 (UTC+8)
Abstract:	研究目的：渴想在物質使用和戒斷後的復發扮演重要的角色，雖然安眠藥的使用與其他成癮物質的使用不同，但過去研究顯示安眠藥在長期使用下仍會出現對安眠藥物的渴想。本研究旨在進一步探討安眠藥物渴想的相關因素，透過部分減藥的操弄與每日的評估，以瞭解減藥、情緒與壓力以及睡眠狀況與安眠藥渴想的關聯性。研究方法：研究招募33位長期服用安眠藥的失眠者（男：女＝15：18；平均年齡41.6歲，標準差11.55歲），進行七天基礎期以及七天減藥期共兩週的研究。在研究期間，研究者每天透過社群媒體（LINE官方帳號）發送線上問卷連結，請研究參與者紀錄其安眠藥渴想、壓力程度、情緒價性（正負向情緒）、情緒強度（激發程度）以及各式睡眠指標。資料分析以階層線性模型（Hierarchical Linear Modeling）來區分受試者間與受試者內的預測效果。研究結果：研究結果發現，減藥期並不會讓研究參與者經驗到更高程度的渴想，但相較基礎期有較負向的情緒以及較差的睡眠品質。受試者內之平均情緒價性（β = -0.24, p = .03）、睡前情緒價性（β = -0.21, p < .01）可預測當天的安眠藥渴想；且減藥期在睡前情緒價性具有調節效果（β = 0.25, p = .01），顯示睡前情緒價性僅在基礎期對渴想具有預測力，在減藥期則無。此外，安眠藥渴想具有個體差異的特性，若參與者失眠嚴重程度指標較高，與睡眠有關的受試者間因素較能夠預測渴想（例如，更負向的睡前情緒價性、更強烈的睡前情緒強度、更差的白天精神）；若參與者失眠嚴重程度指標較低，與情緒有關的受試者內因素較能夠預測渴想（例如，更高的壓力程度、較低的情緒強度）。結論：本研究顯示，渴想不會因為部分減藥而提升。在安眠藥渴想的預測因素方面，從受試者內的資料顯示，個人經驗到的情緒狀態能夠預測安眠藥的渴想；然而從受試者間的資料顯示，渴想不會因個體之間的狀態而有所不同；與睡眠有關之因素則對渴想無顯著預測力。整體而言，安眠藥物的渴想與物質使用有類似之特性，會受到情緒及壓力等非睡眠因素及非藥物本身的因素所影響。再者，若有專業人員協助下減藥，能減少渴想的阻礙。未來在協助失眠者減藥時，應考量其渴想的特性、失眠嚴重程度，以及日常壓力及情緒變化的重要性。 Background:Craving plays a crucial role in the persistence and relapse of substance use. While the use of hypnotics may differ from addictive substances, previous research has reported that long-term use of hypnotics is associated with a craving for hypnotics among individuals with insomnia. The current study aimed to further explore the factors associated with hypnotic craving. By manipulating partial tapering and collecting daily measures, this study investigated the relationship between hypnotic craving and hypnotic tapering, stress, emotions, as well as sleep. Method:Thirty-three participants (Male: Female= 15: 18; age= 41.6±11.55) with insomnia disorder, who had been taking hypnotics for over three months, were recruited for a two-week study consisting of a seven-day usual dosage phase and a seven-day reduced dosage phase. Throughout the study, participants were asked to record their level of hypnotic craving, stress, emotion valence (positive and negative emotions), emotion arousal and to keep a sleep diary every day. Data were collected through responses to questions delivered via a social media app (Line). Hierarchical Linear Modeling (HLM) was employed to examine the relationship between emotion, sleep and craving, for both between-subject and within-subject associations. Results:The findings revealed that participants did not experience heightened craving during the reduced dosage phase compared to the usual dosage phase. However, they reported higher negative emotions and poorer sleep quality during the reduced dosage phase. At the intra-individual level, daily emotional valence (β = -0.24, p = .03) and bedtime emotional valence (β = -0.21, p < .01) were associated with craving. Reducing hypnotic dosage had a moderating effect on bedtime emotional valence (β = 0.25, p = .01), indicating that bedtime emotional valence was predictive only during the usual dosage phase and not during the reduced dosage phase. Furthermore, individual differences were observed in hypnotic craving. Sleep-related predictors (e.g., more negative bedtime emotional valence, heightened bedtime emotional arousal, and poorer daytime vitality) were associated with carving at the between-subject level among participants with higher insomnia severity index (ISI) scores; while emotion-related predictors (e.g., elevated daily stress level and reduced daily emotion arousal) were associated with craving at the within-subject level among participants with lower ISI scores. Conclusions:This study showed that partial tapering of hypnotics did not lead to an increase of hypnotic craving. Regarding predictors of hypnotic craving, negatively-weighted emotions correlated with heightened craving at the within-subject level, while craving did not fluctuated based on emotions at the between-subject level; also, sleep-related factors did not exhibit significantly correlations with increased craving. These results indicated that hypnotic craving shared similarities with substance use, as it was affected by stress and emotions rather than sleep or the hypnotic itself. These findings underscored the advantages of tapering with professional guidance, and the importance of incorporating the management of emotions and stress in reducing craving for hypnotics in individuals with insomnia.
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