第五章、 討論
第五節、 未來展望與研究限制
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應的是個體在面對壓力時容易失眠的傾向 (特質)，而隨著環境的改變，壓力影 響程度，失眠的反應也隨之變化 (狀態)，正如同人格特質會隨著成長及生命歷 程的演進而有所變動，失眠脆弱特質亦是如此，因而失眠脆弱特質可能既是特質，
同時也是狀態。
第四節、失眠相關變項之性別差異
Ohayon (2002) 回顧過去文獻，整理與失眠相關的人口變項資料，如性別、
年齡及教育程度等，結果發現女性、年長者及教育程度較低者有較多的失眠抱怨。
由於本研究的受試者皆為 2006 年於政治大學所招收的大學生，年齡與教育程度 的變異性較小，故本研究僅針對性別變項進行差異性檢定。研究結果顯示女性相 較於男性，有較高的失眠脆弱特性，知覺到較高的壓力影響程度、以及面對壓力 時採用較多情緒焦點因應、問題焦點因應及信教因應方式；而在失眠相關的變項 上，失眠嚴重程度、身心激發程度及睡眠的不當認知未呈現性別差異。過去研究 並未直接探討性別在失眠脆弱特質中的異同，不過在 Drake 等人 (2004) 的研究 中，高失眠脆弱特質組呈現性別差異，女性人數比例顯著多於男性，由此研究結 果可以推論女性傾向擁有較高的失眠脆弱特性。而在知覺壓力程度及壓力因應方 式上，研究結果與過去研究一致，女性相較於男性傾向報告較多的壓力(Baum &
Grunberg, 1991; Collins & Frankenhaeuser, 1978)，此差異可能與男女性評估壓力 的歷程不同所致，而此評估歷程的差異亦可能在因應方式上呈現不同的結果，雖 過去研究在因應方式上並未發現有男女的差異(Hamilton & Fagot, 1988)，不過本 研究結果呈現女性傾向知覺到較高的壓力帶來的影響程度，故而在因應行為上可 能需花費較多的心力處理壓力，而反應出有較高的情緒焦點因應、問題焦點因應 及信教等因應方式。
第五節、未來展望與研究限制
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本研究以 Spielman (1986) 的失眠三因子模式為架構，探討壓力下容易失眠 的脆弱特質對於失眠症狀發生的預測性，以及與其特質相關的失眠病理因素，以 期對於釐清失眠發展的歷程能有所助益。研究結果指出失眠脆弱特質對失眠症狀 之發生有接近顯著的預測性，而擁有此脆弱特質程度較高者在面臨壓力時容易引 發較高的生理激發狀態，此時若個體又傾向使用情緒焦點來因應壓力，即在面臨 壓力時過於仰賴情緒抒發，更可能引發較高的認知激發狀態，而加劇失眠的嚴重 程度。另一方面，因應風格中的逃避因應以及對睡眠的不當認知皆會增加身心激 發的程度，進而加劇失眠的嚴重度。面對壓力時容易失眠的反應一直以來被視為 一種個人特質，且具有個別差異性，故本研究結果應用於臨床上，建議可以失眠 脆弱特質作為篩選未來可能發展為失眠的高危險族群，並盡早針對此族群採取預 防性介入，如教導適當有效因應壓力的技巧，學習採取問題解決的因應方式來管 理壓力，以及面對壓力時的放鬆技巧訓練，以降低其生理或認知激發狀態，並減 緩失眠的發生。
本研究透過追蹤的方式來回答研究問題，對於失眠病因的發展有進一步的了 解，但仍有方法上的限制。首先，本研究乃以現有睡眠調查資料為基礎所進行的 追蹤研究，故在研究架構上受限於已有的資料，較難在設計完整的研究架構下追 蹤探討結果。其次，本研究所追蹤之受試者皆為國立大學的畢業生，其能力表現 亦在平均之上，是否可能受其能力影響，如因應壓力或失眠的技巧較佳，而看到 研究結果中失眠整體嚴重程度偏低，故要將研究結果推論至一般人群仍需更多研 究的支持。再者，本研究結果有 12 位受試者有失眠症狀的抱怨，這之中有 2 位 受試者抱怨白天生活功能受到影響，受試者的失眠嚴重程度偏低。建議未來研究 可以此方向持續追蹤受試者，以釐清這兩群失眠者在失眠相關病理因素以及病程 發展之異同。最後，本研究採階層迴歸方式探討失眠的病理因素對於身心激發程 度及失眠嚴重度的預測性，由迴歸分析所得之結果僅能預測相關病理因素對於激 發程度及失眠嚴重程度之關聯性，其中的因果關係仍不清楚，建議未來研究可擴
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大樣本數，並使用結構方程模型來驗證本研究變項之間的關係，以期可更明確地 釐清病理因素之間的關係，方可針對相關的病理因素對失眠之影響進行因果關係 的推論。
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