第五章 研究討論
第三節 研究限制與未來展望
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藥前先接受此策略，將可能提升其減藥成效。另外，進行 8 週逐步減藥計畫之後 的減藥自我效能改變量(SE10-SE2)一樣可以有效解釋減藥百分比，代表減藥後的 自我效能提升的越高則減藥成效也越好，而這部分的減藥自我效能改變可能受到 個案每週的減藥結果及減藥自我效能相互影響所致，也可能受到減藥前的提升減 藥自我效能策略的持續影響所致，亦或兩者共同影響所致。
第三節 研究限制與未來展望
本研究雖然證實了提升減藥前的減藥自我效能對於個案在執行逐步減藥計 畫能顯著提升減藥的成效，但仍有其方法上的限制。首先，研究對象方面，原發 性失眠的診斷主要依賴臨床醫師的主觀評估，缺少夜間睡眠檢查等客觀評估方 式，無法完全排除個案是否還有其他睡眠疾患共病，因此個案若同時有其他睡眠 疾患(如：睡眠呼吸中止症或週期性肢體抽動症等)，在減藥過程中，由於助眠劑 的減少可能使其他睡眠疾患對於睡眠的干擾變得明顯而降低個案減藥的成效，或 是其他睡眠疾患對於睡眠的干擾本身就較為明顯而使得個案較容易減藥。其次，
少部份個案使用抗憂鬱劑以減緩失眠造成的情緒症狀，而這些個案本身可能就有 較多的情緒症狀表現，也可能會直接或間接干擾減藥成效，但從本研究資料進行 2 因子獨立變異數分析，如表 5-3-1 所示，以組別(自我效能提升組及單純減藥組) 及使用抗憂鬱劑與否(有使用及未使用)為獨變項，減藥百分比為依變項，結果顯 示只有組別有達顯著差異(F(1,44)=3.519，p<.05)，使用抗憂鬱劑與否未達顯著差異
(F(1,44)=.678，p=.415)，交互作用也未達顯著差異(F(1,44)=.001，p=.980)，表示合併
使用抗憂鬱劑的個案對於減藥百分比可能沒有顯著的影響，不過本研究並非以此 為研究目的，故此部分仍有待未來研究作進一步瞭解。另外，個案使用的助眠藥 物種類繁多，作用機制與半衰期也不完全相同，因此也無法完全排除藥物的不同
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對於減藥成效的影響，但從本研究資料進行 2 因子獨立變異數分析，如表 5-3-2 所示，以組別(自我效能提升組及單純減藥組)及助眠劑使用種類(中短效型及長效 型)為獨變項，減藥百分比為依變項，結果顯示組別(F(1,41)=.239，p=.628)，助眠 劑使用種類(F(1,41)=1.893，p=.176)，交互作用都未達顯著差異(F(1,41)=2.631，
p=.112)，表示個案使用不同類型助眠劑對於減藥百分比可能沒有顯著的影響，
不過本研究並非以此為研究目的，故此部分仍有待未來研究作進一步瞭解。最 後，個案的動機不一，部分個案動機可能較低，並未以停藥為主要目標，認為可 以將助眠劑劑量減半或未每天使用就心滿意足，造成減藥歷程可能有所停滯，以 致降低 8 週後的減藥成效。
表 5-3-1
自我效能提升組、單純減藥組在抗憂鬱劑使用與否的減藥百分比
組別 ANOVA
自我效能提升 組(n=24)
單純減藥組
(n=24)
抗憂鬱劑的使 用
組別 抗憂鬱劑的使用
x 組別
變項 Mean SD Mean SD F 值 效果量 F 值 效果量 F 值 效果量
抗憂鬱劑
的使用
有 82.54 12.68 67.99 29.04 .678 - - 3.519* .074 .001 - -
無 76.27 20.98 61.32 35.19
*p<.05
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多，造成自我效能提升組的個案受到研究者的關注較多而提升個案減藥的動機與 意願，使自我效能提升組的個案在減藥表現較好。這些部份都有待未來的研究作 進一步瞭解。
過去的減藥計畫主要聚焦在減藥策略的執行，並未強調心理認知因素的影 響，而從本研究結果顯示，減藥自我效能是一個可以著力的部份，後續研究可以 再將此提升減藥自我效能策略更多元化及精緻化，如：以團體的方式進行，運用 團體成員彼此為模範，以增加個案減藥自我效能，或是運用 Bandura 提出的第 4 個可以增加自我效能的方式，設計可以減少由於減藥引起的情緒激發(emotion arousal)的活動，以避免個案減藥自我效能的降低。
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政大睡眠研究室 NCCU Sleep Lab
減藥策略的療效研究
目前已有許多實徵研究證實減藥計畫對於失眠病人在進行減藥
的療效。例如，2003年英國精神醫學期刊(British Journal of Psychiatry) 此期刊裡一篇針對失眠及焦慮症病人進行減藥治療的研究結果顯 示，在治療結束後兩個月追蹤，減藥計畫對於藥物減量(完全停藥或 使用劑量降低)是有明顯改善的效果。
附錄 2
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政大睡眠研究室 NCCU Sleep Lab
成功減藥案例
案例一
29 歲男性、上班族、睡眠困擾為入睡困難及睡眠品質差，導致白天疲勞及
記憶力變差。自從 4 年前換工作後，因為工作及經濟壓力大，開始出現失眠症狀。嘗試過換床鋪、聽放鬆音樂等方法，但是效用皆不明顯，服用安眠藥約 3 年之久，
睡眠狀況穩定後，經過兩個月認真執行減藥計畫，藥物從原先每天使用兩顆
stilnox，到目前睡前可以不靠藥物即可入眠。
案例二
38 歲職業婦女，睡眠困擾為入睡困難、多夢及睡眠品質不佳，導致白天工 作效率差及情緒易怒。八年前因為婚姻及工作問題，開始出現失眠症狀。近幾年 生活壓力變小，睡眠趨於穩定，但無法靠自己停藥。去年間藉由為期 8 週的減藥 計畫，由於認真配合，因此將藥物由每天 eurodin(悠樂丁)及 stilnox(使蒂諾斯) 各一顆，減至每天只使用 stilnox 半顆，後續仍積極減藥中。
案例三
45 歲家庭主婦，睡眠困擾為入睡困難及睡眠品質不佳，導致白天社交活動 減少及情緒較為憂鬱。10 年前因為先生外遇，開始出現失眠症狀。近幾年婚姻 關係趨於緩和，但安眠藥仍是需要天天服用，曾靠自己將藥物從一顆半減至一 顆，但因擔心干擾睡眠，就不敢再繼續往下減。去年間參加為期八周的減藥計畫，
過程中雖有遭遇挫折，但憑藉著不放棄的精神，目前已順利的將安眠藥物停用。
案例四
56 歲退休男性，睡眠困擾為睡眠時間短及睡眠品質不佳，導致白天精神狀 況不佳及非常疲倦。六年前因為退休後生活作息改變，短時間無法適應而出現失 眠症狀。在使用安眠藥的情況，且配合生活作息的調整，睡眠慢慢也恢復正常，
56 歲退休男性，睡眠困擾為睡眠時間短及睡眠品質不佳，導致白天精神狀 況不佳及非常疲倦。六年前因為退休後生活作息改變，短時間無法適應而出現失 眠症狀。在使用安眠藥的情況，且配合生活作息的調整，睡眠慢慢也恢復正常，