Overcoming insomnia, with Prof Guy Leschziner
发布时间 2023-03-26 23:00:00 来源
摘要
If you suffer from insomnia, you’ve probably heard the same old advice before: don’t drink caffeine in the afternoon, get plenty of exercise during the day, and don’t take your phone to bed. But what if you do all that and still can’t sleep?
To get more insight into insomnia and the techniques shown to overcome it, we speak to Guy Leschziner, Professor of Neurology and Sleep Medicine at King's College London.
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Hello and welcome to Instant Genius, the Bite Size Masterclass in podcast form. I'm Thomas Ling, digital editor at BBC Science Focus magazine.
大家好，欢迎来到即时天才（Instant Genius）——以播客形式呈现的精简大师课堂。我是BBC Science Focus 杂志的数字编辑 Thomas Ling。
If you suffer from insomnia, you've probably heard the same old advice before. Don't drink caffeine in the afternoon, get plenty of exercise in the day and go to bed at the same time each night. So what if you do all of that and still can't sleep?
如果您患有失眠症，您可能之前听过相同的老生常谈的建议。下午不要喝咖啡因，白天要多锻炼，每晚相同的时间上床睡觉。那么如果您做到了所有这些，但仍然无法入睡呢？
Well to find answers about how to finally get some proper rest, I'm speaking to Guy Leschener, author of the secret world of sleep and professor of neurology and sleep medicine at King's College London. In this episode he impacts key tactics to overcoming insomnia, why sleeping pills are problematic at best and also how your sleep tracker could be scuffering your shut eye.
好的，为了找到关于如何最终得到一些适当休息的答案，我正在与盖伊·勒谢纳交谈，他是《睡眠的秘密世界》的作者，也是伦敦国王学院的神经学和睡眠医学教授。在这一集中，他介绍了克服失眠的关键策略，为什么安眠药在最好的情况下也会有问题，以及你的睡眠跟踪器可能会影响你的睡眠。
Hello Guy, welcome to the show.
嗨，朋友，欢迎来到节目现场。
Hello, thanks for having me.
你好，谢谢你邀请我。
So I'm going to start from the very top and with the term insomnia. So insomnia is thrown about quite a lot, but what does it actually mean? Is it just people who have problems falling asleep or is there a more technical definition?
所以我要从最基础的开始，说说失眠这个词。人们常常会用失眠这个词，但它实际上是什么意思呢？它只是指有困难入睡的人，还是有更专业的定义？
Well, I think insomnia really encompasses a range of symptoms, but at the core of it is the inability to sleep when you want to sleep, but crucially associated with daytime symptoms, so symptoms like fatigue or tiredness or cognitive complaints. So it really encompasses people who have difficulty getting off to sleep at the beginning of the night, but also difficulty staying asleep during the course of the night and occasionally individuals who wake up very early when they don't want to. And so really it's the subjective experience of having poor quality sleep and of not being able to sleep when you want to.
嗯，我认为失眠的确包括很多症状，但它的核心是想要睡觉时无法入睡，而且与白天的症状密切相关，比如疲劳或疲惫或认知问题等症状。因此，它实际上包括那些在夜晚开始时入睡困难的人，以及在夜晚过程中保持睡眠困难和偶尔不想起床而提前醒来的人。所以，它真正体现了睡眠质量不佳和无法按照自己意愿入睡的主观体验。
So how many people actually have insomnia?
那实际上有多少人患有失眠呢？
Well, this is incredibly common and whilst many people who are awake in the middle of the night feel very isolated and alone, actually they're a member of a very large club, we know that about 30% of adults in any one year will experience a period of insomnia, but about 10% of the adult population will experience chronic insomnia, which is where they experience insomnia on the majority of days for at least a three month period. So this is a huge problem.
嗯，这是非常普遍的一种情况。很多人在半夜醒来时会感到非常孤独和孤立，但实际上，他们是一个非常庞大的群体的成员。我们知道，在任何一年中，大约有30％的成年人会经历失眠期，但约有10％的成人人口会经历慢性失眠，即他们在至少三个月中的大部分日子里都会出现失眠。因此，这是一个巨大的问题。
So are certain groups more susceptible to suffering from insomnia?
那么是否有些群体更容易受到失眠的困扰呢？
But we know it's a little bit more common in women than men, we know that as we get older insomnia tends to get commoner and in part that may be related to other medical issues, to medications that we're on when we get older to the fact that we're more likely to have pain, more likely to have things like bladder issues and that for example, if you have depression or anxiety it's much more likely to occur. That's not to say that young people without depression or anxiety or any other conditions never have insomnia, of course they do.
但是我们知道，失眠在女性中比男性更为普遍，我们也知道随着年龄增长，失眠也会变得更加普遍，这部分可能与其他医疗问题有关，也可能与我们在老年时服用的药物、更有可能出现疼痛、如膀胱问题等事项有关，举例来说，如果你有抑郁或焦虑问题，失眠更有可能发生。这并不是说年轻人没有抑郁或焦虑或其他状况就不会有失眠，当然他们也会。
So why is it that women could be more susceptible to insomnia than men?
那么，为什么女性比男性更容易患上失眠呢？
Well, I think that that's a subject of great debate. Certainly there are conditions that seem to influence women more than men and those are some of the conditions that are under hormonal regulations. So women are much more likely to experience symptoms that will feed into insomnia like restless leg syndrome. In part that is hormonal, in part that's because women are much more likely to have low iron levels and we know that iron is very important for restless leg syndrome. Certainly there are some psychological issues that tend to be more common in women than men and they remain some debate as to whether or not that's primarily related to underlying biology or it's related to societal issues. There are other medical conditions that women are more likely to experience particularly once again going back to menstrual related symptoms, pain or other symptoms, menopause for example.
我认为这是一个备受争议的话题。肯定有一些情况似乎比男性更影响女性，这些情况受到激素调节的影响。因此，女性更有可能出现会导致失眠的症状，比如不静脉症。这在一定程度上是由于激素分泌，另一方面则因为女性更有可能出现低铁水平，而我们知道铁对于不静脉症非常重要。肯定有一些心理问题在女性中比男性更常见，而这些问题是否主要与潜在的生物学有关还是与社会问题有关还存在争议。还有其他医疗状况，女性更有可能经历尤其是与月经有关的症状、疼痛或其他症状，例如更年期。
So I'm going to ask the probably quite scary question about how insomnia impacts the body physically. So what happens if you consistently don't get an up-sleep?
我想问一个可能会吓人的问题，即失眠如何在身体上产生影响。如果您一直睡不好，会发生什么？
Well, it's important to start off that answer with saying that insomnia and chronic sleep deprivation are not the same thing. So we know that the majority of people with insomnia, so that's subjective experience of poor quality sleep, when you measure their sleep quantity using techniques like monitoring brainwaves, that actually the majority of people don't sleep that much less than normal individuals. So when the sleep may be fragmented, it may be disrupted, maybe broken, but actually the total sleep duration that the experience may not be that different.
首先，需要强调的是失眠和慢性睡眠剥夺不是同一个问题。我们知道，大多数失眠者虽然睡眠质量不佳，但如果使用监测脑电波等技术来测量他们的睡眠时间，实际上他们的睡眠时间与正常人相比没有太大差异。虽然他们的睡眠可能会分散、受到干扰或中断，但实际的总睡眠时间可能并没有太多的不同。
And in fact, we have very good evidence that some of the issues that we are very much concerned about when it comes to chronic sleep deprivation. So these are people essentially who are burning the candle at both ends, things like blood pressure issues, diabetes, obesity, heart disease, are actually not applicable to the vast majority of people with insomnia.
实际上，我们有非常充分的证据表明，当涉及到慢性睡眠剥夺时，我们非常关注的一些问题确实存在。因此，这些人本质上是两头烧的人，例如血压问题、糖尿病、肥胖症和心脏疾病，实际上并不适用于大多数失眠症患者。
So insomnia is obviously very strongly associated with mental health conditions, but that association goes both ways. So we know that anxiety and depression can result in sleep deprivation or insomnia, but we also know that insomnia seems to be an important factor in the development of things like anxiety and depression.
失眠显然与心理健康问题有很强的关联，但这种关联是双向的。我们知道焦虑和抑郁可以导致睡眠剥夺或失眠，但我们也知道失眠似乎是焦虑和抑郁等问题发展的重要因素。
So there are the cognitive or the psychological consequences of insomnia. There is also a growing body of evidence surrounding the association between insomnia and cognitive decline in the long term, so things like dementia.
所以失眠会造成认知或心理上的后果。同时，越来越多的证据表明失眠与认知能力长期下降，例如痴呆症之间有着联系。
Now that is also a rather complex relationship because it may be that actually some of the drugs that are used to treat insomnia might give rise to cognitive decline. It may be that actually one of the very early features of some of these conditions, conditions like Alzheimer's disease may actually be insomnia. And that's certainly something that we're beginning to learn in other areas of neurology.
那是一种相当复杂的关系，因为有可能实际上用于治疗失眠的某些药物可能导致认知能力下降。实际上，这些疾病（如阿尔茨海默病）的早期症状可能是失眠，我们正在其他神经学领域中开始了解这一点。
So for example, in Parkinson's disease, we are now understanding that there are sleep issues that will often proceed the development of Parkinson's disease by years or even decades. And so it's not impossible actually that in the extremely early stages of some of these conditions like Alzheimer's disease, sleep may deteriorate very early on as well. But it may also be possible that actually insomnia influences the likelihood of developing these conditions.
例如，在帕金森病中，我们现在了解到，睡眠问题通常会在帕金森病发展数年甚至几十年前就出现。因此，在某些疾病早期阶段，如阿尔茨海默病，睡眠可能也会非常早地恶化。但实际上失眠也可能影响发展这些疾病的可能性。
And the reason why we think that that might be the case is because we know that one of the functions of sleep is to facilitate the removal of toxins or metabolites, breakdown products of normal life from the brain. And so if you are getting disrupted sleep, poor quality sleep or limited sleep, that might influence those kinds of processes.
我们认为这可能是因为我们知道睡眠的其中一个功能是促进清除脑部的毒素或代谢产物，这些是正常生活的分解产物。如果你的睡眠受到干扰，质量不好或者时间不足，那么这可能会影响这些过程。因此，这也可能影响脑部的健康。
So is there a strong relationship between insomnia and something like anxiety? Well, I think there is a very stronger relationship between the two. So if you think about it, what happened in anxiety? Anxiety is about an elevated level of perceived threat. So you are looking for threats in your environment. And of course, when you are in that sort of low level flight, fright or flight state, then that is going to influence the quality of your sleep because your brain is not going to switch off.
那么，失眠和类似焦虑的问题之间有很强的关联吗？我认为两者之间的关系非常紧密。想想焦虑发生了什么？焦虑意味着你感到威胁加剧。因此，你会在自己的环境中寻找威胁。当你处于低水平的逃避或应战状态时，这当然会影响你的睡眠质量，因为你的大脑无法安静下来。
That's a survival instinct. If you feel that you're under threat, then the last thing you want to do is to go to sleep. So there is that direct association between anxiety and sleep anyway, but we know that if you have poor quality sleep, that is going to elevate your levels of anxiety. Even on a genetic basis, there is an incredible amount of overlap between the genes that influence the development of insomnia and the genes that influence the development of anxiety. So from a genetic perspective, these are other similar conditions as well.
这是一种存活本能。如果你感觉受到威胁，那么你最不想做的事情就是入睡。所以焦虑和睡眠之间存在直接关联，但我们知道，如果你的睡眠质量不好，这会提高你的焦虑水平。甚至从基因角度来看，影响失眠和焦虑发展的基因存在 incredible 的重叠。因此，从遗传学角度来看，这些也是相似的疾病。
I can't put it off any longer and I really need to get into what people really want to know, which is how to overcome insomnia. And I think a good place to start, we'll be talking about sleeping pills. Do any of them actually work? Well, they do. Yes, of course they do.
我再也不能拖延了，我真的需要探讨人们真正想知道的事情，那就是如何克服失眠。我觉得一个好的起点是讨论安眠药。它们中有哪些真的有效吗？嗯，它们确实有效。是的，当然有效。
I think one of the problems with many of the sleeping pills that are available either over the counter or even by prescription is that they have a number of issues associated with them. First is that people very quickly develop a tolerance to these pills. And so once they may shorten your sleep latency, which is the time from which you go to bed and fall asleep and they may improve sleep quality to some extent, that effect is often very short lived. And so within a few days or a few weeks that effect wears off and people tend to require higher and higher doses to get the same effects.
我认为许多市面上可以随意购买的，甚至由处方医生开处方的安眠药存在许多问题。首先，是因为人们很快会对这些药物产生耐药性。因此，尽管这些药物可能会缩短你在床上睡眠的等待时间，提高睡眠质量，但这种效果通常很短暂。因此，在几天或几周内，这种效果就会消失，人们往往需要越来越高的剂量来获得相同的效果。
People often will develop a psychological dependency to these drugs. They will essentially become addicted to them. These drugs are not without side effects. So many of the drugs, particularly some of the prescribed drugs, can result in significant cognitive problems, particularly in the morning, a hangover effect or can even lead to people having crashes when driving a car. So they're not without issues.
人们经常对这些药物产生心理依赖。他们会完全上瘾。这些药物并非没有副作用。很多药物，尤其是一些处方药，可能会导致重大的认知问题，特别是在早晨，出现宿醉效应，甚至可能导致人们开车时发生车祸。所以它们并不没有问题。
And then there is this growing body of literature that is tying some of these drugs with increased risk of cognitive complaints. So that it may be that some of these drugs, when taken long term, are acting as a prelude or maybe increasing your risk of developing conditions like dementia. Now as I've already said, that is a very complex relationship, but certainly it's a good reason to at least consider alternatives to some of these drugs when it comes to fixing sleep.
然后，有越来越多的研究证实，一些药物会增加认知问题的风险。这可能意味着，一些药物如果长期使用，可能会成为阿尔茨海默病等疾病的先兆，或者可能会增加你患这些疾病的风险。正如我已经提到的，这是一个非常复杂的关系，但这肯定是考虑寻找其他解决方案来改善睡眠时的一个很好的理由。
What should somebody do if they can't get to sleep? So this lying in bed waiting for sleep to come and it just doesn't. I think this is probably one of the most common problems with people with insomnia. What should they do? Yeah, so I think the first thing to do is to focus upon aspects of your behaviour that we group into this horrible term called sleep hygiene.
如果有人无法入睡，该怎么办呢？躺在床上等待睡意降临，但它就是不来。我认为这可能是失眠者最常见的问题之一。他们应该怎么办？是的，我认为首先应该关注我们称之为“睡眠卫生”的行为方面。
Sleep hygiene defines these kinds of behaviours that influence sleep. Things like, for example, alcohol use, caffeine usage, exercise during the day, not using nicotine in the hour or so before bed, making sure that your sleeping environment is conducive to sleep. So, you know, quiet, a reasonable temperature and dark, making sure that you are using your bed space for nothing other than sleep.
睡眠卫生包括那些会影响睡眠的行为习惯，比如饮酒、咖啡因摄入、白天锻炼、睡觉前一小时不吸烟，确保睡眠环境适合睡眠，比如安静、合适的温度和黑暗，保证你床上除了睡觉以外没有其他活动。
So it's amazing, particularly with people working from home, how many people have got their home office set up in their bedroom and their brain on a conscious or on an unconscious level, associates their sleeping environment with working, with getting emails, with surfing the internet, with watching television. So these are all things that we term sleep hygiene.
这真是太惊人了，特别是随着在家办公的人越来越多，有多少人把家庭办公室设置在卧室里，无论是在意识水平还是在无意识的水平上，都把自己的睡眠环境与工作、收发邮件、上网冲浪、看电视等联系起来。所以这些都是我们所称的“睡眠卫生”问题。
A lot of people say, well, you know, I've got chronic insomnia, I've tried all these sleep hygiene measures and it hasn't helped my sleep. And it's important to stress that sleep hygiene on its own is probably not an adequate treatment for chronic insomnia.
很多人都说：“你知道吗，我有慢性失眠，我试过所有睡眠卫生措施，但它们并没有改善我的睡眠。”重要的是要强调，仅仅依靠睡眠卫生措施可能无法有效治疗慢性失眠。
And in fact, there are many people who sleep very, very well who will have a espresso before bed or will watch Netflix on their phone until the last possible moment before they switch off the lights. And so sleep hygiene doesn't necessarily make the difference between somebody who's a great sleeper and somebody who's a bad sleeper.
实际上，有很多睡眠很好的人会在睡觉之前喝一杯浓咖啡或者看Netflix直到最后一刻才关灯。因此，睡眠卫生并不一定能决定一个人是睡眠好还是差。
For people with chronic insomnia, actually the gold standard treatment that we recommend as first line is a treatment called cognitive behavioral therapy for insomnia. And we know that this treatment, which we call CBTI for short, is actually a very good treatment for the majority of individuals, and it helps up to between 60 and 80% of individuals reestablish normal sleep patterns.
对于长期失眠患者，我们建议的第一线治疗是一种叫做认知行为疗法失眠的治疗方法。我们知道这种治疗方法（简称CBTI）实际上非常有效，可以帮助大多数人重新建立正常的睡眠模式，有效率在60%到80%之间。
And so if I had one piece of advice for people who suffer from chronic insomnia, is to explore the possibility to get this treatment delivered to them.
所以，如果我要给患有慢性失眠症的人一个建议，那就是探索有可能为他们提供这种治疗方式。
Yeah, that's really really interesting. I think before I did this podcast, I asked around the office if anyone had any questions about insomnia and a few people were asking, just what can I do?
“是啊，真的很有趣。在我做这个播客之前，我问过办公室里的同事，有没有关于失眠方面的问题，有几个人问道，我能做些什么？”
I seem to be doing all the classic sleep hygiene advice. I get plenty of exercise. I go for walk in the morning outside. I've ordered caffeine past midday, going to bed, waking up at the same time every day, not using a phone in bed, but I still can't sleep. Is that the point where someone should be reaching out for further help with CBTI?
我好像在遵循所有经典的睡眠卫生建议。我进行了充足的锻炼，早上在外面散步。我在中午过后不再摄入咖啡因，总是在同一时间上床睡觉并起床，不在床上使用手机。但我仍然无法入睡。这是需要寻求进一步CBTI帮助的时候了吗？
Yeah, absolutely. I mean, it's worth talking a little bit about what we think is going on in chronic insomnia. We know that in chronic insomnia, there are some psychological factors, but there are also some physiological, some biological factors.
是的，绝对的。我是说，值得探讨一下我们认为慢性失眠的原因。我们知道慢性失眠有一些心理因素，但也有一些生理、生物因素。
So those psychological factors can be conscious. And what I mean by that is that, you know, often people who have got chronic issues with sleeping will develop some specific sleep related anxiety. So they will be anxious about the fact that they may not be able to sleep.
因此，这些心理因素可以是有意识的。我的意思是，经常有睡眠问题的人可能会产生某些特定的与睡眠有关的焦虑感。因此，他们会感到焦虑，担心自己可能无法入睡。
They'll be anxious about the fact that they are expecting a horrible night ahead of them. They'll be anxious about the fact that they may not be able to function properly the following day or may not be able to perform their work or social issues or whatever. They may even be anxious about the long-term health implications of not being able to get off to sleep.
他们会因为他们预料到难度重重的夜晚而感到不安。他们担心第二天可能无法正常运作或者不能处理好工作和社交等问题。他们甚至可能会担心长期失眠会对健康带来的不良影响。
But there are also a number of unconscious factors. So we, in some respects, humans are no more glorified than Pavlov's dogs. And that we exhibit this conditioned response to bed. Sleep, the association between bed and sleep is a learnt behaviour as children. And any learnt behaviour can be unlearned.
但是还有许多无意识的因素。因此，在某些方面，我们人类并不比巴甫洛夫的狗更显赞美。我们对床的条件反射睡觉。在童年时期，床和睡眠之间的联系是通过学习得到的行为。任何学习得到的行为都可以被取消学习。
And so can be replaced by negative conditioned response whereby we associate bed with being awake rather than being asleep. And that is on a non-conscious level as well as a conscious level. And so essentially what we need to try and do is to retrain the brain to associate bed with sleep rather than bed with wake.
因此，我们可以用负性条件反射来取代，这样我们就会将床与清醒联系起来，而不是与睡觉联系起来。这是在非意识层面和意识层面上的。因此，我们需要尝试重新训练大脑，将床与睡眠联系起来，而不是将床与清醒联系起来。
And that sleep retraining process is really at the core of cognitive behavioural therapy for insomnia. As the flagship journal of the Royal Society of Chemistry, Chemical Science is home to exceptional research and thought-provoking ideas.
睡眠重新训练过程实际上是认知行为治疗失眠的核心。作为英国皇家化学协会的旗舰期刊，Chemical Science是杰出研究和发人深省的思想的家园。
This journal offers you a trusted platform for your articles to flourish and your unique discoveries to be celebrated. Chemical Science removes barriers to research so you can read every publication and publish your articles for free.
这个期刊为你提供一个可信赖的平台，让你的文章得以充分发展，你的独特发现得以被赞赏。《化学科学》消除了研究的障碍，因此你可以阅读每一篇论文，并可以免费发表文章。
Submit your next paper to elevate your research and gain the recognition you deserve. To find out more, visit rse.li-kempsi.
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It's part of this that classic advice that if you can't get to sleep after say 20 minutes to sort of get up out of bed and go and read something or do something relaxing elsewhere and then only return to bed when you are feeling sleepy, does that hold up?
这个经典建议说如果你躺在床上超过20分钟还是睡不着，就起来去读书或在其他地方做些放松的事情，直到你感觉瞌睡了再回到床上，这个建议还有用吗？
Absolutely, essentially what this is trying to do is it's trying to minimise the amount of time that you are in bed awake. Because the longer you are in bed awake, the stronger that association becomes.
基本上，这个正在尝试做的事情是尽量减少你清醒时在床上的时间。因为你在床上清醒的时间越长，这种关联就越强。
And you know, it's not unsurprising that many people with insomnia, what they do is they try and spend longer in bed. They go to bed a bit earlier, they have a lie in, because they think, well, if I'm going to have rubbish sleep, then I may as well try and maximise the amount of rest or sleep that I'm getting by staying in bed for prolonged period of time.
你知道吗，很多失眠者会试图在床上呆得更久，这并不令人意外。他们可能会早点上床，或者躺在床上多一会儿，因为他们认为，如果他们的睡眠质量很差，那么待在床上更长时间，尽可能地获得更多的休息和睡眠时间，可能是个好办法。
Whereas actually, that is probably rather counterintuitive, one of the worst things that you could do, because you are then strengthening that association between bed and wake rather than building an association between bed and sleep.
实际上，那可能相当不符合直觉。这是最糟糕的事情之一，因为这样做会加强床和清醒之间的联系，而不是建立床和睡眠之间的联系。
So, does sleeping less effectively make you sleep better? In the short term, absolutely. In fact, one of the core features of CBTI is a protocol called sleep compression or sleep restriction.
那么，睡眠时间少了真的能让睡眠更好吗？在短期内，绝对可以。事实上，认知行为治疗的核心特点之一就是一种叫做睡眠压缩或睡眠限制的协议。
Essentially, what this aims to do is it aims to put you into a slightly sleep deprived state whereby it utilises the brain's own mechanisms to drive sleep and tends to force your brain to begin to associate or getting into bed, switching the lights off with drifting off to sleep and then trying to consolidate your night time sleep and over time, the amount of time you are allowed to spend in bed gets lengthened if your sleep quality improves.
本质上，这个目的是想让你处于稍微睡眠不足的状态，从而利用大脑内部的机制来促进睡眠，并强迫你的大脑开始把上床、关灯与入睡联系起来，然后尝试巩固你的夜间睡眠，在一段时间内，如果你的睡眠质量得到改善，你在床上的时间会逐渐增加。
And that's a very effective treatment. In fact, it's probably one of the most effective aspects of CBTI. In Australia, they've developed a treatment called intensive sleep retraining.
那是非常有效的治疗方法。事实上，这可能是CBTI最有效的方面之一。在澳大利亚，他们开发了一种治疗方法叫做密集睡眠再训练。
And whilst I don't necessarily suggest this for people, because it's almost like something out of Guantanamo Bay, it's quite a useful illustration of this at its most extreme. So, imagine that you have chronic insomnia and you can't drift off to sleep when you get into bed.
虽然我不一定建议大家这样做，因为这几乎就像古巴关塔那摩（监狱）的事情，但这是一个很好的极端例子。所以，想象一下如果你患有慢性失眠，无法在上床后入睡。
So, what they do is they say to you, well, the night before you come into the sleep laboratory, we don't want you to sleep at all. So, you come into the sleep lab on that night having not slept at all the night before.
所以，他们跟你说，睡眠实验室前一晚我们不希望你睡觉。所以，在你进入睡眠实验室的那一晚，你前一晚完全没有睡觉。
You're wired up to an EEG machine so that we monitor your brain waves. And then every half an hour, the lights are switched off and you're told to try and go to sleep. Now, if you haven't fallen asleep within about 15 minutes, the lights come on again and they say, okay, stay awake until the next half hour, every half hour on the half hour, if you fall asleep, then after three minutes of sleep is verified by your brain waves, you're woken up again.
你被连接到一个脑电图机上，我们会监测你的脑电波。然后每半个小时，灯光关闭并告诉你尝试入睡。如果你在约15分钟内没有入睡，灯光就会再次亮起，然后告诉你在下一个半小时内保持清醒。每半个小时的时候，如果你入睡了，那么在你的脑电波确认了三分钟的睡眠之后，你会再次被叫醒。
So, essentially, what this means is that over the next 25 hours, you have 50 attempts to go off to sleep. And if you do manage to go off to sleep, you're only allowed to sleep three minutes.
所以，基本上这意味着在接下来的25个小时里，你有50次机会入睡。如果你真的入睡了，也只能睡三分钟。
So, you end up being extremely sleep deprived. So, for people with bad insomnia, they won't fall asleep at all over the first few trials. But by the end of that 25 hour period, because they are so sleep deprived, they will literally fall asleep as soon as they're allowed to.
所以，你最终会变得非常缺乏睡眠。对于患有严重失眠的人来说，在前几次尝试中他们根本不会入睡。但是到了那25小时的结束，由于他们过度缺乏睡眠，他们的确会在允许睡觉的瞬间就睡着了。
And so, what this does is it's very good at rebuilding that association between your head hitting the pillow and lights going off with you drifting off to sleep, rather than what you were left with before, which is when you get into bed and your head hits the pillow, your brain suddenly becomes very active and wide away.
所以，它的作用就是很好地重建你的头碰到枕头并灯光熄灭，你就能进入睡眠的联想，而不是以前的情况，当你上床并把头放到枕头上时，你的大脑突然变得非常活跃和清醒。
And we know that even that very acute treatment can be a very good and effective treatment for people with chronic insomnia. It does sound like quite an extreme technique, but is there anything that somebody could do that's similar to that that they can do from home?
我们知道，即使是那种非常强烈的治疗对于患有慢性失眠症的人来说也是非常好的和有效的治疗方法。虽然听起来像是一个非常极端的技巧，但是有没有类似的家庭治疗方法呢？
Yeah, well, I think that certainly compressing your sleep can be very effective. So, what we generally tend to do is we ask people, well, how long do you think you are actually sleeping in total?
嗯，我认为压缩睡眠时间肯定非常有效。所以，我们一般都会问人们，你认为你睡觉的总时间有多长呢？
And they will say, well, I sleep, for example, six hours a night. And one of the things to do is to say, well, if you are only sleeping for six hours a night, then what you should start by doing is just spending six hours in bed. So, you go to bed at 1am and you wake up at 7am.
他们会说，比如我每晚睡六个小时。其中一件事可以做的就是说，如果你每晚只睡六个小时，那么你应该开始先让自己在床上呆六个小时。所以，你可以在晚上1点钟上床睡觉，早上7点钟起床。
And whatever happens, you will not go to bed before 1am and you will not get out of bed beyond 7am for a short period of time. So, what that tends to do, initially, obviously, that's quite difficult because you go to bed, you're taking ages to get off to sleep, your sleep may be a little bit broken.
无论发生什么，你短时间内不会在1点前上床睡觉，也不会在早上7点后起床。所以，刚开始时很困难，你上床后需要很长时间才能入睡，你的睡眠可能会有点糟糕。
But over time, what will happen is that you will start falling asleep relatively quickly when you get into bed and you will wake up as your alarm goes off at 7am. Now, once that is happening on a consistent basis, then you can start gradually increasing the amount of time that you are in bed.
随着时间的推移，你会发现当你上床后很快就会入睡，而当7点闹钟响起时你会醒来。当这种情况变得稳定后，你可以逐渐增加睡眠时间。
So, after a couple of weeks, you start going to bed at 12.30 rather than 1am and gradually increase it up to a point where you've hit the optimal amount.
那么，在几周之后，您开始在晚上12:30入睡，而不是在凌晨1点，逐渐增加时间，直到达到最佳数量。
So, in that circumstance, if someone's going to sleep at 1am, what should they be doing while waiting for sleep?
那种情况下，如果有人准备在晚上1点入睡，他们在等待入睡时应该做些什么呢？
So, it's the advice about not watching TV. Does that hold? Is that actually a good way for people to unwind before then?
那么，这是关于不看电视的建议。这个建议可行吗？对人们在此之前放松的确是一种好方法吗？
Well, we generally tend to recommend that people try and do something calming and relaxing. And of course, it depends what you're watching on television as to whether or not that's calming or relaxing. One of the big issues, of course, is light exposure. Because we know that what happens with light exposure, particularly light that is rich in the blue part of the light spectrum, is that it suppresses your natural melatonin.
嗯，我们通常建议人们尝试做些平静和放松的事情。当然，这要根据你在电视上看些什么来决定是否平静或放松。当然，其中一个重要问题是光线暴露。因为我们知道，光线暴露，特别是处于光谱中蓝色光的丰富部分，会抑制人体内天然褪黑激素的分泌。
And melatonin is a hormone that your brain pushes out, which is a chemical signal to sleep. So, we know that if you are exposing yourself regularly to bright light, particularly in the evening, that can cause fundamental changes to your body clock and can make it more difficult for you to drift off to sleep.
褪黑素是大脑分泌的激素，它是入睡的化学信号。因此，我们知道如果您经常暴露在明亮的灯光下，尤其是在晚上，那么这可能会对您的生物钟造成根本性的变化，并使您更难入睡。
So, what we would generally recommend is reading on a book on an analogue device rather than a digital device, especially not one that is backlit and listening to music, listening to a podcast, obviously not something as interesting as your podcast, but something that's relatively, relatively un-stimulating. These kinds of activities.
所以，我们通常建议在模拟设备上阅读书籍，而不是数字设备，特别是不要使用背光设备并听音乐、听播客，显然不是像你那么有趣的播客，而是一些比较不刺激的东西。这些活动。
What do you think about sleep trackers? Are you a fan? Are you not a fan?
你对睡眠追踪器有何看法？你是粉丝吗？还是不是粉丝？
Well, I think the sleep trackers are very, very useful from a research perspective. My major issue with sleep trackers is that people who tend to get very involved in tracking their sleep are often the people who already have some anxiety about their sleep. And sometimes that sort of obsessionality about sleep can be fueled by the obsessive tracking of data.
我认为睡眠追踪器从研究角度来看非常有用。我对睡眠追踪器的主要问题是，那些倾向于过度关注睡眠的人往往已经对睡眠有些焦虑。有时，睡眠的这种强迫追踪可能会加剧他们的病态睡眠观念。
And so sometimes actually these sleep trackers can actually feed into insomnia rather than be helpful. In times gone by, one of the big issues was that these sleep trackers were very inaccurate. And so people would often get very anxious about data which in itself was inaccurate and would sometimes diagnose themselves with sleep complaints that they didn't actually have, which was a problem.
所以有时候，这些睡眠跟踪器实际上可能会加重失眠，而不是有所帮助。过去，一个大问题是这些睡眠跟踪器非常不准确。因此，人们常常对不准确的数据感到非常紧张，并有时会自我诊断睡眠问题，而这本身就是个问题。
I think these sleep trackers have become more accurate. There are still some issues in terms of their accuracy, particularly when it comes to people who are not normal sleepers, so people who have sleep disorders. And so generally speaking, I say to people, look, if you are worried about your sleep, if you think your sleep is a poor quality, then please just put the sleep tracker away and go and speak to somebody about your sleep rather than obsessively tracking it.
我认为这些睡眠追踪器变得更准了。然而，在准确度方面还有一些问题，尤其是当涉及到不是普通睡眠者的人，那些有睡眠障碍的人。因此，总的来说，我建议人们注意，如果你担心自己的睡眠质量不好，那么请把睡眠追踪器收起来，去向专业人士咨询，而不是过于沉迷于追踪睡眠。
What about meditation? It's one of these sort of solutions that are often sort of bounded around. Do you think there's any solid clinical evidence that meditation will help in some of the acts?
关于冥想怎么样呢？这种解决方案经常被提及。你认为有没有明确的临床证据表明冥想可以帮助一些行为呢？
Yeah, I mean, I think meditation is another term for sort of spiritually based mindfulness. And we know that mindfulness-based therapies are very useful in trying to address that low-level fright flight or flight response that is so negatively impacting upon sleep. And in fact, there are some mindfulness-based approaches that are part and parcel of cognitive behavioral therapy for insomnia.
是的，我的意思是，我认为冥想是一种基于灵性的正念(注意力)的另一个说法。我们知道，基于正念的治疗在尝试缓解那种严重影响睡眠的低水平惊恐或逃跑反应方面非常有用。实际上，有一些基于正念的方法是失眠认知行为治疗的重要组成部分。
So I think as part of the overall treatment strategy for chronic insomnia, I think these can be very useful indeed. Could it help with that anxiety that people have before bed? Earlier you were saying that whether people know it or not, they are having that performance anxiety about sleeping?
我认为，作为慢性失眠的整体治疗策略的一部分，这些方法确实非常有用。它们能帮助缓解睡前的焦虑吗？您之前说过，无论人们是否意识到，他们都会对睡觉产生表现焦虑？
Yes, absolutely. I think that that is very much helpful for some of that sleep-related anxiety and a variety of different techniques are used in standard sleep therapy to try and help be that progressive muscle relaxation and other mindfulness-based approaches, distraction techniques, a whole range of things.
当然啦。我认为这对于一些与睡眠有关的焦虑非常有帮助。在标准的睡眠治疗中，使用了许多不同的技巧，例如渐进性肌肉放松、基于正念的方法、分散注意力技巧等等。总之，各种方法都被尝试着来帮助睡眠问题。
So I think really, if mindfulness or meditation works for you, then absolutely you should be doing that as part of your standard behavior pre-sleep. You sort of mentioned a few then, but be good if you could unpack a bit about some of the other techniques that people could use to process that anxiety before sleep.
所以我认为，如果正念或冥想适合你，那么你应该将其作为你睡前标准行为的一部分。你提到了一些技巧，但如果你能解释一下人们可以使用哪些其他技巧来处理睡前的焦虑，那就更好了。
You've already mentioned meditation or meditation-based techniques. I think that there are a number of other strategies that people can use. So there's a strategy called progressive muscle relaxation, which is where you concentrate on various muscle groups within your body and you tense them and then relax them in an effort to try.
你已经提到了冥想或基于冥想的技巧。我认为人们可以使用许多其他策略。所以有一种叫做渐进性肌肉放松的策略，你集中注意力在你身体内的各种肌肉群上，先让它们绷紧再放松，这是一种努力的方法。
Well, first of all, it's about distracting you away from the process of getting off to sleep, but it's also quite a useful technique for relaxation. There are visualization techniques. So, for example, imagining that you're in a pleasant place and journeying through.
首先，这是为了让你远离入睡的过程，但也是一种非常有用的放松技巧。有可视化技巧。例如，想象自己在一个愉快的地方旅行。
I think the key thing is that there are a lot of different ways in which you can try and distract yourself from the process of going off to sleep, including, as you said, listening to a podcast or an audio book or something else.
我认为关键的事情在于，有许多不同的方法可以尝试分散注意力，让自己进入睡眠状态，比如你所说的听播客、有声书或其它事情。
And essentially, what we're trying to do is we're trying to avoid people focusing on the process of getting off to sleep because individuals with insomnia is that process itself that creates anxiety.
基本上，我们想做的是避免人们关注入睡过程，因为失眠症患者会因此产生焦虑。
But by the way, one of the very common things that people with insomnia describe is that they will say, well, you know, I'm sitting on the sofa reading a book or watching television and I will feel myself overcome with sleep and will feel myself dosing off. And then as soon as I get into bed, I suddenly feel wide awake. There's this sort of paradoxical alerting response.
顺便说一下，失眠的人经常会描述这样一件事情，就是他们会说：“你知道吗，我坐在沙发上看书或看电视，忽然感觉很困，感觉自己在睡着，但是一上床，我却突然变得很清醒。” 这种相反的兴奋反应称为矛盾兴奋反应。
And I think that very much illustrates the fact that when people are not focused on drifting off to sleep, they will drift off to sleep. But as soon as they're focused on drifting off to sleep, they'll be unable to.
我想这很清楚地说明了一个事实，那就是当人们没有专注于入睡时，他们会睡着。但是一旦他们专注于入睡，他们就会无法入睡。
What happens? What is going on? If somebody's feeling quite sort of generally sleepy before bed able to get off fine, but then sort of still wake up several times at nights with these anxious thoughts.
发生了什么事？发生了什么事情？如果有人在睡前感到有些昏昏欲睡就能够很好地入睡，但是接着在晚上还是会因为这些焦虑的想法而多次醒来。
So that can be obviously part and parcel of insomnia. And in some individuals, it seems that the brain is rather better than in other individuals, when you're very sleep deprived of overcoming that insomnia, which is why you're falling asleep very easily. But then once that pressure has been taken off by a few hours of sleep, then the insomnia comes to the fore.
这可能很明显地成为失眠的一部分。在一些人身上，当你非常睡眠不足来战胜失眠时，似乎大脑比其他人更出色，这就是为什么你会很容易地入睡。但是一旦经过几个小时的睡眠后，这种压力就被减轻了，失眠问题就浮出水面了。
But it's important to recognize that there are, of course, other sleep disorders that can give rise to recurrent awakenings at night. So conditions like obstructive sleep at me are where people have a problem with their breathing at night and that results in recurrent awakenings. Conditions like periodic limb movement disorder, which is a neurological disorder that results in recurrent kicking or twitching, it's sometimes associated with a conditional restless leg syndrome. And that can result in fragmentation of sleep in recurrent awakenings as well.
但是我们需要认识到，当然还有其他睡眠障碍可能会导致夜间反复醒来。像阻塞性睡眠呼吸暂停症这样的情况，人们在晚上呼吸有问题，会导致反复醒来。像周期性肢体动作障碍这样的神经系统疾病，会导致反复踢或抽搐，有时会和条件性不宁腿综合症有关。这也可能会导致睡眠破碎和反复醒来。
So it's not the case that everybody who wakes up repeatedly at night and wakes up feeling unrefreshed has got insomnia. They may have other sleep complaints.
因此，并不是每个经常在夜间醒来并感到没有精力的人都有失眠症。他们可能有其他的睡眠问题。
If someone was looking to get diagnosed with a sleep disorder like that or were looking to find help about some of the techniques you mentioned, CBTI is the best approach to go to their doctor? Yes, go into your GP.
如果有人想被诊断为睡眠障碍，或者想了解你提到的一些技巧的帮助，CBTI是最好的方法，他们应该去看医生吗？是的，去看你的家庭医生。
So one of the problems historically within the NHS has always been that CBTI has been very poorly provided for. But actually over the last couple of years, there have been a number of different digital platforms. So essentially these are web-based platforms that run through CBTI with you. That you can actually access either free or free with a GP referral.
历史上NHS面临的一个问题一直是CBTI很少得到提供。但其实在过去的几年中，出现了许多不同的数字平台。这些基本上是基于网络的平台，可以一起进行CBTI。你可以免费获得它们，或在GP的推荐下免费获得它们。
And so I think that if you are experiencing insomnia, then absolutely the first thing that you should be doing is exploring one of these digital CBTI platforms. Going and having a chat with your GP may well ascertain that there may be other things at play that might be giving rise to your sleep difficulties.
我认为，如果你正在经历失眠，那么你应该首先探索这些数字化CBTI平台，这是绝对必须的。和你的家庭医生聊一聊可能会发现其他因素可能导致你的睡眠困难。
A lot of these CBTI platforms have got a sort of pre-initiation questionnaire where they try and highlight those individuals that may have something else going on and may recommend that you go and see your GP before embarking on CBTI because there is a high suspicion that you may have another sleep disorder.
很多 CBTI 平台都有一种预备问卷，试图强调那些可能有其他问题的人，并建议你在进行 CBTI 之前去看一下你的 GP，因为存在非常高的怀疑，你可能有其他睡眠障碍。
This might be putting you on the spot of it. But what is the most misunderstood thing about insomnia that you can think of? I think the most misunderstood issue is the fact that people think that if they have insomnia, they should be spending more time in bed.
这可能会让你感到不舒服。但你认为关于失眠最被误解的事情是什么？我认为最被误解的问题是人们认为如果他们失眠了，就应该在床上呆更长时间。
The other issue is the fact that actually what we know is that we are very poor witnesses to our own sleep. And the objective measures of sleep and subjective experience of sleep can all often be vastly different.
另一个问题是，实际上我们了解自己的睡眠非常不准确。睡眠的客观测量和主观体验经常会有很大的不同。
So essentially you should be going to the doctor to see if you have one of these sleep disorders. If it's quite hard to tell objectively from the outside to what your sleep is like.
所以基本上你应该去看医生，看看你是否有这些睡眠障碍。如果从外部客观地判断你的睡眠状况很困难。
Well, I think certainly if you're subjective experience of sleep is very poor, then that tells you what you need to know about your sleep. So if you are sleeping what you feel to be an appropriate duration but you wake up feeling unrefished or sleepy, then that suggests you've got a problem. If you are unable to sleep when you want to sleep and sleeping very and waking up feeling very bad, then it suggests that you have a problem with your sleep. If you are sleeping okay and you have no daytime symptoms, then that's just your sleep is okay for you.
我认为，如果你主观经验的睡眠质量很差，那就可以告诉你你的睡眠问题所在了。所以，如果你睡觉的时间正常，却醒来感到疲倦，那就意味着你有问题了。如果你想睡觉却无法入睡，醒来时感到非常不舒服，那就表明你的睡眠有问题。如果你睡得好，并且在白天没有任何症状，那么你的睡眠就很好了。
Is there anything that I should have asked but didn't?
有没有我应该问但却没有问到的问题？
I think along the lines of what we were just discussing is a lot of people experience what we turn paradoxical insomnia, which is when they feel that they have slept very little or slept very poorly, but they're a recording of their brain waves shows that they've actually slept a very good amount.
我觉得刚才我们讨论的内容大致是很多人会经历所谓的“逆反性失眠”，这是指他们会感觉自己睡得很少或者睡得很差，但是他们的脑电图记录显示实际上他们睡得非常充足。
Now we used to think of that as primarily as a psychological phenomenon but I think that what that really illustrates is the fact that the brain can exist in different stages of wake or sleep at the same time. And I think that this phenomenon is responsible for many of the kind of weird and wonderful things that we see in clinical sleep medicine like sleep paralysis or hallucinations at night or sleepwalking for example.
我们曾经认为这主要是一种心理现象，但我认为它实际上展示了大脑可以同时存在于不同的清醒或睡眠阶段的事实。我认为这种现象负责了许多我们在临床睡眠医学中看到的奇怪和美妙的事物，比如夜间的睡眠瘫痪、幻觉或梦游。
But actually in paradoxically insomnia, what we think is going on is that there are small areas of the brain that actually are in much less deep sleep than other parts of the brain and those parts of the brain are primarily responsible for awareness. So whilst the majority of your brain is actually getting very good sleep, it may simply be that the parts of your brain that are responsible for awareness or consciousness are not quite as deep sleep as they should be.
实际上，在矛盾的失眠中，我们认为发生的是大脑中有小区域比其他部分的睡眠要浅得多，而这些部分的大脑主要负责意识。因此，虽然大部分大脑实际上正在获得非常好的睡眠，但可能仅仅是负责意识或意识的大脑部分没有达到应有的深度睡眠。
So is there any way of telling if you have paradoxical insomnia? Well I think the easiest way of telling if you've got paradoxical insomnia is to record your brain waves which is not very easy to do. But the other way for example that it often comes to light is for example I will ask patients well how much do you think you slept last night and they'll say I didn't sleep at all and then their partner will say well you snored all the way through the night. I think that's a very good indication that they've got paradoxical insomnia for example.
那么有没有什么办法可以判断你是否患有矛盾性失眠呢？嗯，我认为最简单的方法是记录你的脑电波，但这并不是很容易做到。但另一种方法，比如经常出现的情况是，我会问病人昨晚你认为你睡了多久？他们会说我一夜没睡，但他们的伴侣会说你整晚都在打鼾。我认为这是他们患上矛盾性失眠的非常好的指示。
That was Professor Guy Leschenov author of the secret world of sleep and professor of neurology and sleep medicine at King's College London.
这是 Guy Leschenov 教授，他是《睡眠的秘密世界》一书的作者，也是伦敦国王学院的神经学和睡眠医学教授。
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