关于安必恩和失眠

嗯，我以前单身一人住，只能躺在床上痛苦地翻来覆去。

Well, I I was single living on my own, and I would just lay in my bed in agony.

那时候智能手机还没普及。

And this was really before smartphones.

但我就是躺在床上辗转反侧。

But I would just lay there tossing and turning.

然后，当然了，我会去看钟表。

Then, of course, I would look at the clock.

这是卡罗琳。

This is Caroline.

她有失眠症。

She has insomnia.

我一辈子都住在俄亥俄州的哥伦布市，今年42岁。

I have lived my entire life in Columbus, Ohio, and I am 42 years old.

我认为很多人描述失眠及其带来的精神痛苦时都会说：如果我现在睡着了，至少还能保证六个完整的小时睡眠。

I think many people have sort of described insomnia and the mental anguish it causes in this way that if I fall asleep now, I still have an opportunity to get six solid hours.

这种情况会发展到一个地步，当时钟一点点走到只剩下四小时左右，或者你看到天开始亮了，但马上就得去上班，整个人精疲力尽，状态糟糕，完全不在状态。

And it gets to a point where once the clock whittles down to, you know, maybe four hours or you see the sunlight coming up, but then it's time for work and you have to go into work just depleted, looking terrible, feeling terrible, and not on your game.

但到了那天晚上，你又会想：今晚我一定要好好睡一觉。

But, of course, that night, you're thinking, I'm going to get a good night's sleep tonight.

但结果还是老样子，又睡不着了。

But then it just happens again.

你还记得你第一次吃阿普唑仑的那天晚上吗？

And do you remember that first night that you took an Ambien?

你还记得那感觉是什么样的吗？

Do you remember what that was like?

你知道吗，这说起来挺有意思的。

I you know, it's funny.

我确实记得。

I actually do.

我大概提前二十分钟服了药，突然间，笔记本电脑的屏幕开始波动，一切都变得特别好。

I had taken the dose maybe twenty minutes prior, and all of a sudden, the the laptop screen was wavy and everything was great.

生活太美好了。

Life was great.

那时候，你根本没法让我沮丧。

You couldn't say anything to get me down at that point.

我没有充满活力。

I was not full of energy.

我非常平静。

I was very mellowed out.

我很开心。

I was happy.

我很放松。

I was relaxed.

这是一种欣快感。

It was a euphoria.

这种感觉持续了大约十五到二十分钟，然后我就想：哇。

That lasted maybe fifteen, twenty minutes before I was like, wow.

我真的很累。

I'm really tired.

我睡得比很久以来都要好，因为第二天我想，今晚一定要好好睡一觉，因为那种药实在太棒了。

I slept better than I had in quite some time because the next day I thought, I'm gonna sleep tonight because that medication was fantastic.

但后来卡罗琳开始注意到一些奇怪的事情。

But then Caroline started to notice strange things.

然而，我发现自己很快就会醒来，发现一些我煮过的锅和一盒盒的意大利面，但我完全不记得自己做过这些。

I found myself though quickly waking up to pans and boxes of pasta that I had cooked and I did not remember.

情况进一步发展成我做了些打电话和发短信的事，而我却完全不记得。

It progressed into making phone calls and texts that I didn't remember.

这让我有点害怕。

And so that was a bit frightening.

它影响了我正在维持的一些恋爱关系。

It impacted some romantic relationships that I was in.

我那时正和一个男人交往了大约六个月。

I had been seeing a man for around six months.

我真的很喜欢他，但他结束了这段关系，因为有一晚我吃了阿普唑仑， apparently说了些什么，但我根本不知道自己说了什么。

I really liked him and, he had ended the relationship because one night I had taken an Ambien and I apparently had said something and I don't even know what I had said to him.

我向他解释过，阿普唑仑有时会导致这种情况，但他似乎并不相信。

And I had explained to him that Ambien can sometimes cause that, and he was I guess, didn't believe it.

是的。

Right.

我的意思是，吃这种药的利弊都很明确：你确实需要它来睡觉，但这些副作用却相当严重。

I mean, it sounds like they were very clear pros and cons to to taking this drug, that there were benefits that you you needed to sleep, but all these kind of side effects that were quite significant.

没错。

Absolutely.

曾经有一次，我想开车。

And there was a time one instance one instance where I wanted to drive.

我不敢想象会发生什么，因为我根本记不得了。

And I don't wanna think about what would have happened because I don't even remember it.

我的邻居当时在场，拦住了我。

And my neighbor was there and stopped me.

我只是觉得自己是个坏人，因为别人对我的反应表现出担忧甚至厌恶。

I just felt like a bad person, I think, because of the reactions that others were having expressing concern or even disgust.

但我还是继续服用它。

I yet I just kept taking it.

我想，哇。

And I thought, wow.

这太恶心了，或者说是肮脏的，因为你因为这个失去了两段关系。

This is this is disgusting or it's dirty because you're you've lost two relationships because of this.

你的母亲都为你担心。

Your own mother's worried.

所以，是的，这让我觉得自己不是一个很好的人。

So, yeah, it just made me feel like a not great person.

大概两年后，我才开始逐渐减少服用。

It was probably two years after that I started to taper off of it.

这真是一个药物故事。

This is drug story.

我是托马斯·戈茨。

I'm Thomas Goetz.

今天这个药物故事讲的是安必恩，也叫通用名佐匹克隆。

Today's Drug Story is about Ambien, also known by the generic name zolpidem.

佐匹克隆是一种安眠药，是有史以来最受欢迎的安眠药。

Zolpidem is a sleeping pill, the most popular sleeping pill ever invented.

多年来，它帮助了数百万人。

It has helped millions of people over the years.

但就像睡眠本身仍是一个谜一样，佐匹克隆也展现出比最初设想的更加奇特和令人担忧的特性。

But just like sleep is something of a mystery, zolpidem also turned out to be a lot more curious and concerning than originally thought.

卡罗琳的故事比你想象的要普遍得多。

Caroline's story is much more common than you might think.

她与失眠作斗争，而她的焦虑让入睡变得更加困难。

Her struggles with insomnia and the way that her anxiety made it harder to sleep.

非常多的人都有同样的困扰。

Many, many people have the same troubles.

而安必恩，这种情况也很常见。

And the Ambien, that's also common.

大约有两百万美国人服用它来帮助入睡。

About two million Americans take it to help them sleep.

这些副作用的发生频率远高于1992年FDA批准该药物时的预期。

And those side effects, they happen much more frequently than was expected back when the drug was approved by the FDA in 1992.

卡罗琳所寻找的，正是许多人想要的——一种能帮助他们获得休息的药物。

What Caroline was searching for is what a lot of people want, a medicine that helps them get some rest.

大约每三个人中就有一人偶尔会遭受失眠之苦。

And about one in three people suffer from sleeplessness every once in a while.

你知道那是什么感觉。

And you know what that's like.

睡不好觉，第二天会变得非常糟糕。

Not getting a good night's sleep, it can make for a really horrible next day.

你感到迟钝、易怒。

You're sluggish, irritable.

就是感觉很糟糕。

It just feels bad.

但慢性失眠真的会让人痛苦不堪。

But chronic insomnia, that can be truly miserable.

它会对日常生活造成深远的破坏。

It can be profoundly destructive to daily life.

如果有一种像安必恩这样的药物，哪怕能带来几个小时的休息，对很多人来说，风险似乎也值得承担。

And if there's a drug like Ambien that gives even a few hours of rest, well, for many people, the risks seem worth it.

我认为人们很难理解这一点，因为他们觉得失眠患者和自己偶尔睡不好的情况是一样的。

I think it's hard for people to relate to that because they think of the people suffering from insomnia as the same as them when they have a bad night here or there.

这位是安德鲁·克里斯塔尔医生。

This is doctor Andrew Crystal.

他是本集关于失眠和治疗失眠的特邀专家。

He is our resident expert on insomnia and treating sleeplessness in this episode.

他是加州大学旧金山分校（UCSF）的精神病学和神经学教授，领导着该校的睡眠研究项目。

He is a professor of psychiatry and neurology at UCSF, the University of California, San Francisco, where he leads programs in sleep research.

你知道，睡不好觉从来都不是件愉快的事。

And, you know, it's never pleasant to have a bad night.

但当这种情况持续多年时，会对人造成非常严重的负面影响。

But when it's persistent and going on for years for people, it takes a very significant toll on them.

有些人特别容易在压力、健康问题或其他困难情况下出现睡眠紊乱，他们长期遭受困扰，严重影响了生活质量。

There are some people who are particularly prone to having disturbed sleep under settings of stress or health issues or other kinds of problems, and they have persistent difficulty and it impairs their lives in significant ways.

但只有大约百分之十五的人会经历这种长期的睡眠障碍，并因此在白天的功能上受到显著影响，这才是我们所认为的失眠群体。

But it's only about fifteen percent that has this kind of protracted difficulty with sleeping that is associated with impairment in their ability to function during the day, and that really make up the group we think of as having insomnia.

在本期《药物故事》中，我们将踏入被称为睡眠的甜美虚无，以及被称为失眠的地狱折磨。

In this episode of Drug Story, we're going to step into that sweet oblivion called sleep and that infernal torment called insomnia.

我们将了解为什么失眠如此根植于我们的现代生活，同时探索被称为安慰剂效应的谜题——这是判断药物是否真正有效以及多大剂量才真正安全时令人困扰的一部分。

We're going to learn why insomnia is such a part of our modern world, And we're going to explore that riddle called the placebo effect, which is a vexing part of figuring out whether a medication actually works and just how much of that medication is truly a safe dose.

更多精彩内容，尽在《药物故事》。

That's all coming up on Drug Story.

为了营造氛围，接下来播放一段勃拉姆斯的摇篮曲。

And to set the mood, here's a bit of Brahms' lullaby.

《Drug Story》由GoodRx赞助。

Drug story is sponsored by GoodRx.

每一种处方都有其故事，对许多患者而言，可负担性是其中关键的一章。

Every prescription has a story, and for many patients, affordability is a defining chapter.

GoodRx让患者更容易找到处方药的更低价格，无论是GLP类药物还是流感药物，让费用不再成为获得治疗的障碍。

GoodRx makes it easier to find lower prices on prescriptions, from GLP ones to flu meds, so cost isn't a barrier to care.

每年有近三千万美国人和超过一百万医疗专业人士信赖GoodRx，它在全美七万多家药房提供优惠，帮助人们开始并持续使用维持健康的治疗方案。

Trusted by nearly 30,000,000 Americans and over 1,000,000 health care professionals each year, GoodRx offers savings at more than 70,000 pharmacies nationwide, helping people start and stay on the therapies that keep them healthy.

要开始节省开支，请访问goodrx.com/drugstory。

To start saving, go to goodrx.com/drugstory.

网址是goodrx.com/drugstory。

That's goodrx.com/drugstory.

GoodRx不是保险。

GoodRx is not insurance.

《Drug Story》每期节目分为三个部分：诊断、处方和副作用。

Each episode of Drug Story has three parts, the diagnosis, the prescription, and side effects.

这是第一部分：诊断，我们将探讨药物背后的潜在病症。

This is part one, the diagnosis, where we explore the underlying condition behind the drug.

在今天的节目中，这个病症是失眠。

In today's episode, that condition is insomnia.

睡眠困难无疑和人类一样古老。

Having trouble sleeping is surely as old as humanity itself.

在《旧约》中，《约伯记》对这种挣扎有恰当的描述。

In the Old Testament, the book of Job has an apt description of the struggle.

我躺下时说：我何时才能起来，黑夜何时才结束？

When I lie down, I say, when shall I arise and the night be gone?

我翻来覆去，直到天亮。

And I am full of tossing to and fro until the dawning of the day.

但我们所称的医学病症——失眠（拉丁语意为“无睡眠”）——却是近现代才出现的概念。

But the medical condition we call insomnia, which is just Latin for no sleep, that is a much more recent creation.

而形容长期失眠者的人——失眠症患者——则完全是现代的概念。

And the word for people who suffer from chronic sleeplessness, insomniacs, that is an altogether modern idea.

事实上，失眠这种紊乱与现代生活、现代时代紧密相连，我将论证这种生活形态和条件是在1875年至1900年这一特定历史窗口中出现的。

In fact, the disorder of insomnia is intertwined with the very idea of a modern life, a modern age, a time and a condition that I will argue emerged in a very specific window of history from 1875 to 1900.

从那几年的一系列发明清单中，我们可以看到现代生活工具箱的完整图景。

A list of inventions from those years serves as an inventory of the toolbox for modern life.

电话、电灯、洗碗机、自行车、汽车、收音机、回形针、拉链、火柴、吸管，还有数十种其他发明。

The telephone, the light bulb, the dishwasher, the bicycle, and the automobile, the radio, the paper clip, the zipper, matches, and drinking straws, and dozens more.

所有这些现代工具都在一个前所未有的创新爆发期中被发明出来。

All of these modern tools were invented in a burst of innovation unprecedented in human history.

而这些改进都是在人类生活尺度上的。

And these were improvements at the human scale.

每一项发明，哪怕是拉链，都承诺让日常生活的辛劳变得更简单、更舒适。

Each of these inventions, even zippers, came with the promise of making life's daily toil a little less complicated and a little more comfortable.

这些发明为人们提供了一个无法抗拒的通往未来的步伐，让生活或许不再那么辛苦。

These things offered an irresistible step into the future when life maybe wouldn't be quite so much work.

当时一项最了不起的发明的广告曾这样承诺。

An advertisement for one of the era's most marvelous creations promised.

一旦尝试过，此后就总会使用。

If once tried, this will always afterwards be used.

这项伟大的发明是打孔卫生纸，于1891年获得专利。

That great invention was perforated toilet paper, patented in 1891.

这些惊人的发明创造了一个充满电力与动感的世界。

These amazing inventions created a world buzzing with electricity and motion.

这是一个机器、噪音与光明的时代。

It was an era of machines and noise and light.

所有这些现代性催生了一种全新的现代疾病——神经衰弱。

All this modernity created a whole new malady of the modern age, neurasthenia.

这种神经性疾病被认为是由现代城市的压力与喧嚣引起的。

This was a nervous disorder brought on, it was believed, by the stress and hubbub of the modern city.

神经衰弱是由过度紧张、睡眠不足以及日常都市生活的狂热所导致的。

Neurasthenia was caused by too much tension, too little sleep, and too much frenzy in everyday urban life.

神经衰弱在美国似乎尤为严重，那里对幸福的追求越来越意味着对物质的追逐，比如那些承诺让生活更轻松的发明。

Neurasthenia seemed especially bad in America, where the pursuit of happiness increasingly meant a pursuit of stuff, like those inventions promising to make life easier.

事实上，神经衰弱常被称为‘美国病’，这一术语在19世纪90年代由哲学家威廉·詹姆斯推广开来。

In fact, neurasthenia was often called Americanitis, a term popularized in the eighteen nineties by the philosopher William James.

詹姆斯将其描述为美国人过度紧张、急躁、气喘吁吁、情绪激烈以及表达时的痛苦状态。

James described it as the American overtension and jerkiness and breathlessness and intensity and agony of expression.

这种疾病的首要症状是慢性疲劳和失眠。

And the primary symptoms of this disorder were chronic fatigue and insomnia.

毫无疑问，神经衰弱主要是一种白人上层阶级的疾病。

Neurasthenia was, to be sure, largely a white upper class malady.

毕竟，要参与这个现代世界，享受发明的成果，你就得购买所有这些小工具。

After all, to participate in this modern world, to enjoy the fruits of invention, well, you had to buy all those gadgets.

神经衰弱不仅仅是一个美国问题。

Neurasthenia was not just an American problem.

1906年的《英国医学杂志》指出，

The British Medical Journal in nineteen o six noted that

没有任何一种人类疾病能像神经衰弱那样紧紧追随文明的进步。

There is no human disorder which so doggedly shadows the advance of civilization as neuras thenia.

就在那时，'失眠者'一词进入了大众话语，失眠被视为一种极其现代的病症。

It was around then that the word insomniac entered popular discourse, and insomnia was pegged as an exceptionally modern condition.

一本女性杂志的一篇文章写道，

One article in a woman's magazine said,

我们夜间生活得太久在电光的刺眼之中。

we live too much in an electric glare by night.

《纽约时报》认为纽约市是世界失眠之都。

The New York Times suggested that New York City was the insomnia capital of the world.

它估计这座城市有近七十万失眠者。

It estimated that the city was home to nearly seven hundred thousand insomniacs.

这占了整个城市人口的惊人百分之二十。

That would have been a whopping twenty percent of the city's entire population.

随着时间推移，神经衰弱作为一种诊断逐渐淡出，因为现代生活本身已变成了常态。

In time, neurasthenia faded as a diagnosis as modern life just became, well, life.

但失眠，却将长存于此。

But insomnia, that was here to stay.

今天，我们生活在一个24/7、永不停歇的文化中，文明不仅助长了失眠，甚至变得彻底敌视睡眠本身。

Today, we live in a twenty four seven, March culture where civilization doesn't just contribute to insomnia, it has become downright antagonistic to the idea of sleep itself.

睡眠是脆弱人类的非理性弱点，是未能将生产力凌驾于生物需求之上的失败。

Sleep is an irrational weakness of frail humans, a failure to optimize productivity over biology.

但你不必是马克思主义者，也能相信资本主义是睡眠的敌人。

But you don't have to be a Marxist to believe that capitalism is the enemy of sleep.

只需看看‘拼命文化’内部，睡眠被视为一种摩擦、一种效率低下的表现，应当被最小化和抵制。

Just take a peek inside hustle culture where sleep is considered a friction, an inefficiency that should be minimized and resisted.

这里是我们最喜欢的几个‘早起奋斗者’的例子。

Here's just a few of our favorite rise and grinders.

人们经常问我每天睡多久。

People ask me all the time how much I sleep.

拼命的人不睡觉。

Hustlers don't sleep.

我们只小憩。

We nap.

我平时工作日大多在早上4点起床。

I wake up at 4AM most days during the week.

但并不是每次都能那么容易做到。

It's not that easy all the time.

这需要一些时间适应，还得用上几招技巧。

It does take some getting used to and takes a couple tricks.

第一招，设置多个闹钟。

The first one, set a bunch of alarms.

我的第一个闹钟在早上4点响起。

My first alarm goes off at 4AM.

然后我会再设置几个闹钟，分别在04:15、04:16、04:17、04:18、04:19和04:20。

I then have one go off at 04:15, 04:16, 04:17, 04:18, 04:19, and 04:20.

事实上，很多时候睡眠只是让人烦心，因为它又多了一件事要处理。

In fact, sleep a lot of times just becomes annoying because it's just one more thing.

它几乎成了我们必须忍受的必要之恶，只有熬过去，才能迎来第二天， hopefully 能做点事情。

It's almost a necessary evil that we have to get through in order to get to the next day where we can hopefully get some things done.

因为说实话，你靠四个小时的睡眠也能撑得住。

Because honestly, you can run on four hours.

你完全可以只睡四个小时，照样运转良好。

You can run on four hours of sleep just fine.

所有这些都真是让人反感。

All of that is just, yuck.

努力文化的核心理念认为，成功的道路是由个人的痛苦与牺牲铺就的，而首先要牺牲的就是睡眠。

The whole premise of hustle culture says that the road to success is paved with personal pain and sacrifice, and the first thing to sacrifice is sleep.

这与关于男性气概和软弱的陈词滥调紧密相连，这并不奇怪。

It's deeply entwined, not surprisingly, with cliches about masculinity and weakness.

这一切都太‘兄弟文化’了。

It's all very bro bro.

如今，努力文化并不是唯一对睡眠的攻击。

Hustle culture isn't the only attack on sleep these days.

消费科技本身就被有意设计成以优化注意力分散和多任务处理为目标。

Consumer technology itself is intentionally designed to optimize for DAOs and hows.

这是科技圈的说法，指的是日活跃用户和小时活跃用户，其实就是一种衡量公司或产品平均每天能从我们生活中榨取多少小时的方式。

That's tech speak for daily active users and hourly active users, which is just a way to measure how much time out of twenty four hours a company or product can suck out of our lives on average.

这些产品通过自动播放、无限滚动以及其他各种手段，故意设计成让我们保持清醒。

These things are made to keep us awake with autoplay and endless scrolling and whatever other tricks they can muster.

对Facebook、TikTok和Netflix来说，睡眠是我们与它们实现最大利润之间的障碍。

To Facebook and TikTok and Netflix, sleep is what stands between us and their maximum profit.

事实上，几年前，Netflix首席执行官里德·哈斯廷斯在与华尔街分析师交谈时，就坦率承认了这一点。

In fact, a few years ago, Netflix CEO, Reed Hastings, was talking with Wall Street analysts, and he admitted as much.

想想看，当你看一部Netflix剧集并上瘾的时候。

You know, think about it when you watch a show from Netflix and you get addicted to it.

你知道，你会熬夜到很晚。

You know, you stay up late at night.

我们实际上是在与睡眠争夺每一分钟的时间。

You're you're really we're competing with sleep on the margin.

因此，这是一片非常庞大的时间资源。

And so it's a very large pool of time.

里德·哈斯廷斯亲口说了出来。

Reed Hastings said it out loud.

睡眠是商业的敌人。

Sleep is the enemy of commerce.

这真是太疯狂了。

It is just crazy.

当然，社交媒体和屏幕让人更难入睡这一点并不新鲜。

Of course, it's not news that social media and screens make it harder to sleep.

但令人惊讶的是，甚至失眠也被商业化和商品化了。

But what is surprising is how even insomnia has been commercialized and commodified.

我在为这一集做研究时发现的一个奇怪的网络角落，是专门为游戏玩家设计的补剂世界。

One of the weird corners of the Internet that I found while researching this episode was the world of supplements made exclusively for gamers.

也就是那些整天玩电子游戏的人，其中许多人是职业选手。

That is people who spend all day, you know, playing video games, many of them professionally.

我知道。

I know.

如今，许多公司生产各种专为游戏玩家设计的补充剂。

Today, many companies make various supplements designed for gamers.

有改善认知功能的促智药。

There are nootropics, which claim to enhance cognitive function.

当然，还有能量类补充剂，通常只含有咖啡因和牛磺酸。

And, of course, there are energy supplements, which usually just contain caffeine and taurine.

此外，还有一些专为帮助玩家在长时间游戏后入睡而设计的补充剂，名称如‘过场动画’和‘禅意加’。

And then there are also supplements made to help gamers sleep after a long binge with names like cutscene and zen plus.

它们的神奇成分是什么？

Their magic ingredients?

通常是褪黑素和洋甘菊之类的东西，但这是专为游戏玩家设计的。

Typically, stuff like melatonin and chamomile, but, you know, for gamers.

但这些产品真的如宣传般有效吗？

But do these products work as intended?

我们无从得知，因为补充剂不受美国食品药品监督管理局监管。

We have no idea since supplements are not regulated by the FDA.

这些产品真的包含它们所声称的成分吗？

Do these products even include the ingredients they claim to include?

我们无从得知，因为它们同样不受FDA监管。

We have no idea because, again, they are not regulated by the FDA.

针对游戏玩家的助眠补充剂，只是所谓的失眠产业中的一小部分。

Sleep supplements for gamers are just one sliver of what's been called the insomnia industry.

这是一个蓬勃发展的行业，涉及REM追踪可穿戴设备、日出闹钟、特制床垫，以及无数的补充剂，还有众多在优化类播客中频繁出现的睡眠科学专家、心理学家、神经科学家和精神科医生。

The booming business of REM tracking wearables and sunrise alarm clocks and special mattresses and so many supplements and so many sleep science gurus, psychologists, and neuroscientists and psychiatrists who make the rounds on optimization podcasts.

他们提供睡眠科学前沿的最新突破。

They offer the latest breakthroughs from the frontiers of sleep science.

他们承诺揭示改善睡眠的七个秘密。

They promise reveal the seven secrets to better sleep.

这是一个从自身问题中获利的产业。

This is an industry that profits from its own problem.

显然，这种现象没有尽头。

There is apparently no end to it.

我认为睡眠之所以让人如此着迷又困扰，部分原因在于它既是生理的，也是心理的。

I think part of the reason why sleep is such an area of fascination and vexation for people is that sleep is both physical and psychological.

睡眠显然具有生物学功能。

Sleep clearly serves a biological function.

我们会感到疲倦，然后睡觉，醒来后感觉焕然一新。

We get tired, we sleep, and we wake up refreshed.

本来就应该这样运作。

That's how it's supposed to work.

对大多数人来说，通常确实如此。

And for most people, it usually does.

我们本可以聊聊细胞修复和抗体生成，但就不展开了。

We could get into cellular repair and antibody production, but we we just won't.

那是另一个节目了。

That's a different show.

简而言之，我们的身体需要睡眠，这对我们的健康有益。

Basically, our bodies need sleep, and it's good for us.

然后就是心理层面了。

And then there's the psychology.

睡眠通过梦境处理我们的恐惧、想法和记忆。

Sleep processes our fears and ideas and memories through dreams.

睡眠帮助我们将日常的混乱转化为意义与瞬间。

Sleep helps us turn the messiness of our days into meaning and moments.

睡眠还能降低我们的压力，让我们在早晨更加平静。

Sleep also lowers our stress and gives us more calm in the morning.

这是一种每晚一次的心理重启。

It is a once a night psychological reset.

这就是所谓‘睡一觉再说’的全部含义。

That's the whole idea of sleeping on it.

在今天好好休息之后，我们更能应对昨天的心烦事。

We're better able to tackle yesterday's heart problems after we've had some rest today.

不过，可能会陷入一个恶性循环。

A vicious cycle can set in, though.

睡眠不足会让我们压力增大，而压力又会让入睡更加困难。

Lack of sleep makes us stressed, and stress makes it harder to sleep.

睡眠不足与许多健康问题有着密切关联。

And lack of sleep that has been strongly associated with a great many health problems.

而这些问题中的许多，确实会让入睡变得更加困难。

And many of those problems, well, they make it harder to sleep.

就是这样。

Voila.

这是我们自己制造的永久性失眠循环。

A perpetual insomnia machine of our own creation.

这种情况能糟糕到什么地步？

How bad can this all get?

最近发表在《健康数据科学》期刊上的一项研究发现，睡眠质量差与高达172种不同疾病的风险增加相关。

Well, a recent study in the journal Health Data Science found that poor sleep quality was associated with increased risk for a staggering one hundred and seventy two different diseases.

172种，其中包括帕金森病和二型糖尿病。

172, and that included Parkinson's disease and type two diabetes.

这项研究在几天内登上了所有新闻头条。

This study was all over the news for a couple days.

睡眠与172种疾病相关。

Sleep linked to 172 diseases.

这似乎证明了睡眠不好对我们整体健康非常、非常有害。

It seemed proof that bad sleep is very, very bad for us in general.

但这项研究也有些荒谬，因为到什么程度才算过度了呢？

But the study, well, it was also sort of absurd because at what point does it become overkill?

如果失眠几乎与你能想到的每一种疾病都有关，这到底意味着什么？

If insomnia contributes to pretty much every disease you can think of, what does that even mean?

那么，良好的睡眠就能预防172种疾病吗？

Does good sleep then prevent a 172 diseases?

睡眠是包治百病的良方吗？

Is sleep the cure to everything?

当然不是。

Of course not.

事实证明，这项研究存在一个经典的‘相关不等于因果’问题。

It turns out that this study suffers from a classic correlation is not causation effect.

这些关联只是统计上的相关性。

These connections are only statistical associations.

它们可能是完全偶然的，根本不存在因果关系。

They could be entirely coincidental and not causal at all.

更重要的是，这项研究发现睡眠时长——即人们获得的睡眠小时数——几乎没有任何影响，而大多数人正是用这个标准来衡量睡眠质量的。

What's more, the study found almost no effect from sleep duration, how many hours of sleep people got, which is how most people think about sleep quality.

所以，当你越过那些误导性的标题——‘睡眠与172种疾病相关’——你会发现，这实际上相当令人失望，就像失眠产业中许多所谓科学的宣传一样。

So when you read past the misleading headlines, sleep link to 172 diseases, it's actually kind of a disappointment, like a lot of what passes for science in the insomnia industry.

失眠产业就像一条吞食自己尾巴的蛇。

The insomnia industry is like a snake eating its own tail.

奋斗文化将失眠神化，而优化文化则承诺有方法可以治愈它。

Hustle culture fetishizes insomnia, and optimization culture promises the protocols to cure it.

这两者相互滋养，都是我们当前‘美国病’的体现，即我们渴望做得更多、做得更好的双重欲望。

These things feed off of each other, both of them symptoms of our current Americanitis, our twin desires to do more and to do better.

这就是21世纪生活的本质。

That's what living life in the twenty first century is all about.

对吧？

Right?

我们仍在应对与一百五十年前祖先们相同的问题。

We are still dealing with the same stuff our forebearers were a hundred and fifty years ago.

这又是神经衰弱的再现。

It's neurasthenia all over again.

现代生活让我们所有人都成了失眠者，这就引出了一个非常简单的想法——安眠药。

Modern life is making us all insomniacs, which brings us to the very simple idea of a sleeping pill.

一颗药丸，让一切烦恼消失。

One pill to make it all go away.

真的存在一种既有效又安全的安眠药吗？

Is there such a thing, really, as an effective and safe sleeping pill?

事实证明，这是一个非常难以回答的问题，接下来我们会明白为什么。

It turns out that is a very hard question to answer, and we'll see why coming up.

为了铺垫背景，这里有一个名为Somenex的药物的古老广告。

To set the stage, here's a very old commercial for a drug called Somenex.

因为轻微的神经紧张而睡不着吗？

Can't sleep because of simple nervous tension?

服用Somenex，享受一个美好的夜晚和一个清爽的早晨。

Take Somenex to enjoy a good night sleep and a good right morning too.

Somenex含有三种医学成分。

Somenex contains three medical ingredients.

今晚服用Somenex，安然入眠，安稳休息。

Take Somenex tonight and sleep safe and restful sleep.

睡吧。

Sleep.

睡吧。

Sleep.

服用两片Salmonix片剂，然后入睡。

Take two salmonix tablets and sleep.

欢迎回来。

Welcome back.

这是第二部分，处方部分，我们将探讨所讨论药物的出现，今天是安必恩，这种药物也被称为通用名佐匹克隆。

This is part two, the prescription, where we look at the arrival of the drug in question, which today is Ambien, the medication also known generically as zolpidem.

几十年来，制药公司一直在追求一种完美的安眠药，它能让我们入睡，且安全无任何副作用。

For decades, pharmaceutical companies have chased the promise of a perfect sleeping pill, one that puts us to sleep and is safe without any side effects.

这一追求是一段艰难甚至有时充满危险的旅程。

That quest has been a difficult and sometimes perilous journey.

在美国，助眠药物自20世纪50年代起就已在柜台销售。

In The US, sleep aids have been sold over the counter since the nineteen fifties.

柜台销售意味着这种药物无需处方，因为其活性成分被认为相对安全。

Over the counter means a medicine that doesn't require a prescription because the active ingredient is considered reasonably safe.

这些是超市货架上的产品，而不是放在药剂师柜台后面的药品。

These are the products on the shelves at the grocery store, not the ones behind the pharmacist's counter.

我们刚才听到的关于Somenex的广告，就是一种柜台销售的产品。

That commercial we just heard for Somenex, that is sold over the counter.

顺便说一下，Somenex 这个名字巧妙地玩了个文字游戏，源自 'somnolent'，意思是昏昏欲睡的。

Somenex, by the way, is a cute play on the word somnolent, meaning sleepy.

多年来，Somenex 的活性成分是一种名为甲吡咯烯的抗组胺药，这种药物以引起嗜睡而闻名。

For many years, the active ingredient in Somenex was an antihistamine called methapyrolene, which was known to cause drowsiness.

但事实证明，它并不那么安全。

But it turns out it wasn't all that safe.

在二十世纪七十年代，人们发现它会导致大鼠患肝癌，因此被禁用了。

In the nineteen seventies, it was found to cause liver cancer in rats, and it was banned.

如今，Salmonix 的活性成分是一种不同的抗组胺药，名为苯海拉明，通常被认为是安全的，但长期使用与痴呆症有关。

The active ingredient in Salmonix today is a different antihistamine called diphenhydramine, which is considered generally safe, though long term use is associated with dementia.

苯海拉明也是其他非处方助眠药物的活性成分，包括 Unisom、泰诺 PM、Nital 和 Zequel。

Diphenhydramine is also the active ingredient in other over the counter sleep aids, including Unisom, Tylenol PM, Nital, and Zequel.

这不过是同一种药物的不同包装。

This is the same drug in different packages.

顺便说一下，苯海拉明也是苯那君（Benadryl）的活性成分。

Diphenhydramine, by the way, is also the active ingredient in Benadryl.

这算是个题外话，但值得说一说。

And this is a digression, but it's worth it.

如果你比较一下价格，就会发现苯海拉明通常只有一般助眠药价格的一半左右，尽管成分完全一样，只是包装不同、定价不同。

If you compare prices, you will see that Benadryl often costs about half as much as the sleep aids, even though it's the same drug, just a different package at a different price.

一般来说，当你在药房或杂货店购买非处方药时，应该根据活性成分来选购，而不是看品牌。

In general, when you're buying an over the counter medicine at the pharmacy or grocery store, shop for the active ingredients, not the brand.

这是《药物故事》给出的一个实用建议。

That is a pro tip from Drug Story.

无论如何，抗组胺药确实会让人犯困，但你并不总能睡醒后感觉神清气爽。

Anyway, antihistamines do make you drowsy, but you don't always wake up refreshed.

抗组胺药可能导致第二天昏昏沉沉、头脑不清，这就是所谓的宿醉效应。

Antihistamines can make you sluggish and foggy headed the next day, what they call a hangover effect.

而且人们会很快产生耐受性，意味着几天后，常规剂量就不再有效了。

And people quickly develop a tolerance, meaning the drug loses effectiveness at a normal dose after a few days.

因此，人们继续寻找更好的替代品。

So the search for something better continued.

这意味着处方药，也就是只有医生才能开具的更强效的药物。

And that means prescription drugs, stronger drugs that only a doctor can prescribe.

1982年，美国食品药品监督管理局批准了一种名为Halcyon的处方药，用于治疗失眠。

In 1982, the FDA approved a new prescription drug called Halcyon for the treatment of insomnia.

Halcyon属于苯二氮䓬类药物，这类药物当时被广泛用于治疗焦虑。

Halcyon was a benzodiazepine, a class of drugs that was widely used at the time to treat anxiety.

如果你听过我们关于阿普唑仑的那期节目，那也是一种苯二氮䓬类药物。

If you heard our episode on Xanax, that's also a benzodiazepine.

如今，我们知道这些药物可能非常危险。

Today, we know that these drugs can be very dangerous.

人们可能会产生耐受性和依赖性，并且会有包括意识模糊、睡眠行为异常甚至健忘在内的副作用。

People can develop tolerance and dependence issues, and they have side effects, including confusion, sleep behavior problems, even amnesia.

但当时，Halcyon被认为比其他安眠药更安全，尤其是巴比妥类药物，后者后来被证明极其危险。

At the time, though, Halcyon was considered safer than other sleeping pills, especially barbiturates, which turned out to be very dangerous drugs.

很快，Halcyon成为了全球最畅销的安眠药。

Soon, Halcyon was the world's best selling sleeping pill.

在Halcyon上市后的十五年里，全球发放的处方量高达110亿张。

As many as 11,000,000,000 prescriptions were dispensed worldwide in the fifteen years after it reached the market.

但在FDA批准不到十年后，Halcyon的阴暗面开始显现。

But in less than a decade after FDA approval, the dark side of Halcyon started to emerge.

在1990年的回忆录《黑暗可见》中，利亚姆·斯蒂龙称Halcyon引发了自杀念头。

In his 1990 memoir, darkness visible, Liam Styron said Halcyon caused suicidal thoughts.

菲利普·罗斯将精神崩溃归咎于Halcyon。

Philip Roth blamed Halcyon for his mental coming apart.

他说，这种感觉就像拔牙一样真实而具体。

It was as distinctly physical a reality as a tooth being pulled, he said.

1991年，Halcyon的生产商Upjohn公司与一名女子达成和解，该女子在服用该药后开枪打死了她82岁的母亲。

In 1991, Upjohn, the maker of Halcyon, settled a lawsuit brought by a woman who had shot and killed her 82 year old mother after taking the drug.

到这时，质疑开始浮现。

By this point, questions started to emerge.

Upjohn公司是否故意隐瞒了该药严重心理副作用的证据？

Had Upjohn deliberately concealed evidence regarding the serious psychological side effects of the drug?

《60分钟》做了一期关于这场争议的报道。

Sixty minutes did a segment on the controversy.

尽管该公司否认隐瞒任何数据，但该药物于1991年在英国被禁用。

And while the company denied hiding any data, the drug was banned in The UK in 1991.

在美国，FDA开始对所有关于Halcyon的临床数据进行系统性审查。

In The US, the FDA began a systematic review of all the clinical data about Halcyon.

完美的安眠药变成了噩梦。

The perfect sleeping pill had become a nightmare.

就在此时，Ambien问世了，一款时机完美的新药。

And just then, along came Ambien, a new drug with perfect timing.

就在Halcyon市场崩溃之际，Ambien似乎提供了一种更安全的替代品，且没有任何令人恐惧的副作用。

Just as the market for Halcyon collapsed, Ambien seemed to offer a safer alternative with none of the scary side effects.

Ambien由法国制药公司赛诺菲研发。

Ambien was developed by the French pharmaceutical company Sanofi.

让这种药物令人兴奋的是它的作用机制和营销方式。

What made the drug so exciting was how it worked and how it was marketed.

以下是安德鲁·克拉斯特医生的再次发言。

Here's doctor Andrew Crystal again.

很明显，他们的目标是将这种药物与苯二氮䓬类区分开来，因为医生们对苯二氮䓬类有着非常负面的看法。

It was very clear that their goal was to differentiate the drug from benzodiazepines because it was such a negative view that the practitioners have had of it.

事实上，'苯二氮䓬'这个词指的是某种化学结构，所有被称为苯二氮䓬的药物都具有这种化学结构。

The reality is that the word benzodiazepine refers to a chemical structure, and all those drugs called benzodiazepines have that chemical structure.

唑吡坦并不具备这种结构，因此从技术上讲它不属于苯二氮䓬类，但它的作用机制却非常相似。

Zolpidem doesn't have it, so it's technically not a benzodiazepine, but its action has a lot in common.

它结合了大脑中相同的位点，但他们付出了巨大努力来将其与其他药物区分开来。

It binds to the same site in the brain, but they worked really hard to differentiate it from other drugs.

他们说，我们想称它为非苯二氮䓬类药物——这纯粹是个营销策略，你知道，你也可以称它为非阿片类药物。

They said, we want to call this a non benzodiazepine, which, I mean, with just simply a marketing idea, you know, you could also say it's a non opioid.

它是非非甾体抗炎药。

It's a non non steroidal anti inflammatory agent.

它是非，你知道的，化疗药物。

It's a non, you know, chemotherapeutic agent.

这是一种非阿司匹林。

It's a non aspirin.

阿司匹林，没错。

Aspirin, exactly.

这完全正确。

And that's all true.

这不算虚假广告。

It's not false advertising.

只是在这种情况下，它确实让人们对这种药物与苯二氮䓬类药物的区别产生了过度的强调，我认为这可能有些过头了。

It's just, you know, in this case, it really led people to differentiate the drug from the benzodiazepines in a way that I think is maybe more than was merited.

所以事情就是这样。

So there it was.

安必恩于1992年上市，并大获成功。

Ambien arrived in 1992, and it was a huge hit.

1997年，美国食品药品监督管理局允许直接面向消费者的广告后，处方量更是激增。

Prescriptions took off even more in 1997 after the FDA allowed direct to consumer advertising.

电视广告让安必恩看起来像完美的助眠药。

TV commercials made Ambien seem like the perfect sleeping pill.

到2006年，它已成为美国第九大处方药。

By 2006, it was the ninth most prescribed drug in The United States.

同年，它甚至获批用于儿童。

That same year, it was even approved for use in children.

那么，会出什么问题呢？

So what could go wrong?

不过，我们稍后会谈到这一点。

Well, we'll get to that coming up.

但在那之前，先来看一段2000年的安必恩广告。

But first, here's a commercial for Ambien from 2000.

正如我们常说的，这不是付费广告。

As we always say, this is not a paid ad.

这是新闻报道。

This is journalism.

听一下。

Take a listen.

生活是有节奏的。

There is a rhythm to life.

我们晚上睡觉，早上醒来。

We sleep at night and wake in the morning.

正是这种睡眠周期帮助我们保持健康平衡。

It's this sleep cycle that helps keep us in a healthy balance.

但对数百万美国人来说，入睡并不总是那么容易。

But for millions of Americans, sleep doesn't always come easy.

幸运的是，有安必恩。

Fortunately, there's Ambien.

安必恩是一种处方助眠药，能帮助你获得一整晚的睡眠。

Ambien is a prescription sleep aid that can help you get a full night's sleep.

使用安必恩，你能快速入睡，睡得更久，通常第二天早上醒来也不会感到昏昏沉沉。

With Ambien, you fall asleep fast, stay asleep longer, and generally wake without feeling groggy the next morning.