heredity

intrauterine influences

Developmental:

poor parental bonding

poor socialization

learned helplessness paradigm (uncontrollable

stress)

PREDISPOSING

Pacemaker properties:

abnormal period

abnormal limits of entrainment

weak &/or altered coupling

altered sensitivity &/or

response to zeitgebers

PRECIPITATING

maturation/aging

hormonal state

season

primary sleep disorders

physical trauma

Changes in Temporal Order:

family, social, work, meal disruption

jet lag

shift work

unusual pattern of chosen behavior

breakdown/loss of social interactions

separation or death

PERPETUATING

Zeitgebers

absent or weak

phase shifts

change of photoperiod

Stress:

symbolic significance of losses

learned helplessness paradigm

(uncontrollable stress)

PROTECTING

absence of predisposing factors

lithium, tricyclics, NAOI’s

sleep-wake manipulations

light exposure

absence of predisposing factors

normal 24-hr social cues

activity scheduling

timing of treatments

stress management