#107 为何你无法入睡（以及如何解决）| 迈克尔·格兰德纳博士

如果你无法站在床边，或者觉得那样太傻，那就坐在床上挺直身子。

If you can't stand next to your bed, if that's a little too silly for you, sit and sit up on your bed.

不要只是稍微靠着。

Don't not like just a little propped up.

你的头不要枕在枕头上。

Your head's not on a pillow.

不要盖着毯子。

You're not under a blanket.

坐直。

Sit up.

这样你就不会忽视身体的信号。

Again, you're not gonna lose touch of your body's signals.

最坏的情况，至少你会点头打瞌睡。

And and worst case scenario, at least you get the head bob.

点头打瞌睡是你的朋友。

The head bob is is is your friend.

点头意味着你的身体在告诉你已经准备好了。

The head bob means it's your body telling you you're ready.

还有比如当你在看电视或躺在沙发上时，如果处于可能想睡觉的状态，看电视或电影或刷手机时试着前倾身体，因为这样你会出现点头现象。

There's also like if you're watching TV or on the couch or whatever, and you're within that zone where you might be wanting to go to bed, lean forward when you're watching TV or your movie or whatever or scrolling because you'll get the head bulb.

后仰时就不会出现这种情况。

You won't get it when you're leaning back.

前倾时才会出现。

Get it leaning forward.

这就是你身体准备好的信号。

That's your signal that you're ready.

那如果有人在半夜醒来后开始反复思考呢？

And what happens if, you know, someone wakes up in the middle of the night and then they're ruminating?

嗯。

Yeah.

无法入睡。

Can't fall asleep.

再次强调，睡眠不是你主动去做的事情。

So, again, sleep is not something you do.

它是当环境条件允许时自然发生的状态。

It's something that happens when the situation allows for it.

如果当下环境不允许睡眠，那就起床。

And if the situation is not allowing for sleep in that moment, get up.

就像你坐着吃饭时没食欲，不会一直盯着食物直到产生饥饿感。

If you're sitting there and you're eating and you have no appetite, you don't just sit there and stare at your food till you become hungry and it becomes more appetizing.

实际上这会产生反效果。

It actually backfires.

人们半夜醒来通常是因为某些自然因素导致了觉醒。

So often when people wake up in the middle of the night, it's because it's because something naturally occurred to produce that awakening.

最常见的大概是某种身体不适，比如疼痛，或是床垫下陷带来的轻微不适。

Whether most commonly would probably be some sort of physical discomfort like pain, or maybe you sunk into your mattress a little bit and and and it's just a little discomforting.

这时你需要起床活动一下。

You need to wake up and move.

有时是未经治疗的睡眠呼吸暂停症。

Sometimes it's untreated sleep apnea.

非常常见。

Super common.

你经历了一次不自知的呼吸事件。

You have a respiratory event that you don't know you had.

如果你曾无故突然醒来却不明原因且无法再次入睡，我们稍后会讨论睡眠呼吸暂停，但这确实可能导致这类觉醒。

If you ever wake up suddenly for no reason and you don't know why and can't get back to sleep, you know, we'll talk a little bit later about sleep apnea, but but that can cause these awakenings.

当某种源自你体内、不受你控制的因素引发了这种觉醒时。

And when you have something that causes this awakening that arose from inside you, wasn't under your control.

最终结果是这种生理激活会不断升级。

And what ends up happening is that that physical activation escalates.

就像水晶球一样，摇晃后需要时间让雪花重新沉淀。

And just like a snow globe, you know, you shake up the snow globe, it takes a little bit of time for it to come back down.

当你的'水晶球'在睡梦中被摇晃而醒来时，这个过程会更快。

And when your snow globe got shaken up while you were asleep and you're awake, faster.

你对此无能为力。

There's nothing you can do.

你可以戳它让它变慢，但无法让它加速。

You can poke at it, make it go slower, but you can't make it go faster.

你只能等待一切重新平静下来。

You just have to wait till everything settles back down.

通常这不会像人们想象的那么久，但随着雪花球逐渐稳定，你的压力又开始慢慢上升。

And it often doesn't take as long as people think, but what ends up happening is as your snow globe is settling, then your stress starts rising again, slowly rising.

因为你会想：为什么我睡不着？

Because, like, why can't I sleep?

要是我一直睡不着怎么办？

What if I can't fall asleep?

要是我整晚都醒着怎么办？

What if I'm up the rest of the night?

吧啦吧啦吧啦吧啦。

Blah blah blah blah blah blah.

然后你开始为此感到压力和恐慌。

And then you start stressing and freaking out about it.

所以现在你的身体准备好了，但你的大脑却还没准备好。

So now your body is ready, but your mind isn't anymore.

我得等它平复下来，而你却延长了这个过程。

And I gotta wait for that to come down, and you just prolonged it.

既然你无法控制这部分，那就放弃这种控制。

The because you don't have control over this part, surrender that control.

要认识到你终会起床。

Recognize that you're gonna get up.

你可以起床。

You can get up.

休息一下，等你准备好了再试一次。

Take a break, wait till you're ready, try again.

只是不要再不必要地延长这个过程。

Just don't prolong it any more than is necessary.

所以有时候放弃控制反而能缩短清醒时间。

So sometimes surrendering control actually shortens the awakenings.

有时候则不然。

Sometimes it doesn't.

有时候，你知道吗？

Sometimes, you know what?

要是你整晚都醒着再也睡不着怎么办？

What if you're up for the entire rest of the night and you just don't go back to sleep?

这往往是人们害怕的情况。

That's often people's fear.

但事实是：第一，这不太可能发生。

But the truth is, a, that's unlikely.

第二，即便真的发生了，第二天你也不会有事。

And b, even if it does happen, you'll be fine the next day.

再比如，如果你吃到一半突然没胃口了，剩下的饭就不吃了，会怎样？

And guess what happens if you're halfway through your dinner and you just lose your appetite and you just don't eat the rest of it?

第二天会发生什么？

What happens the next day?

你不会死。

You don't die.

你只是会稍微饿一点，第二天会多吃一些，身体系统会自行调节。

You just are a little more hungry, and you'll eat a little more the next day, and the system will correct itself.

过度调节才是问题所在。

Overcorrecting is the problem.

那么根据我的理解，关于刺激控制

So to to kind of just from my understanding, for the stimulus control

对。

Yeah.

比如，对这些人来说最重要的部分是，他们确实存在这种对失眠的恐惧

Like, the most important part of it, like, for these for these individuals that do have this, like, fear of, like, not sleeping Right.

或者说，他们一想到这个就会立即产生焦虑

Or, like, it starts to you know, they they just immediately get, like, anxiety about it.

最好的办法是顺其自然，还是说这是刺激控制中最关键的部分？

The best thing is to surrender, or is that, like, the the strongest part of the stimulus control?

对。

Yeah.

这是表现焦虑。

It's the performance anxiety.

恐惧正是制造阻碍你前进的激活因素。

The fear is what's creating the activation that's getting in your own way.

所以要认识到这不是你能控制的，试图控制它无济于事。

So so recognizing that it's not under your control, Trying to control it is not going to help.

没有人能通过更努力尝试而更快入睡。

Nobody got to sleep faster by trying harder.

睡眠的敌人是努力。

The enemy of sleep is effort.

如果你在付出努力，就是在给系统注入能量。

If you're engaging in effort, you're adding energy into the system.

运动员尤其容易受此影响，因为你知道，运动员习惯于掌控自己的身体，学习如何以大多数人根本不知道的方式控制身体，因为他们没有受过这样的训练。

And athletes especially are vulnerable to this because, you know, athletes are used to gaining control over their body and learning how to control their body in ways that most people just don't know how to because they haven't been trained to.

所以那里总有一个可解决的问题。

So there's always a solvable problem there.

有时就像是伤病恢复。

Sometimes it's like like injury recovery.

有时你无法加速这个过程。

Sometimes you can't make it go faster.

就像你受伤了，就必须做该做的事来恢复。

Like, you injure yourself, you gotta do what you gotta do to recover.

没有什么舞蹈能跳，也没有什么书能读，能让恢复过程加速。

You can't there's no, like, dance you can do or or book you can read that will make that recovery go faster.

你必须给予它所需的时间。

You gotta give it the time it needs.

同样地，这是一个你无法控制的过程。

Similarly, this is a process that's outside of your control.

试图控制它反而会让进程变得更慢。

Trying to control it will actually make it go slower.

好的。

Okay.

所以CBTI的下一部分，你知道，就是那个...对。

And so the the next part of, you know, CBTI that, you know Yeah.

你听说的是这个听起来很糟糕的睡眠限制疗法。

You hear about is this sleep restriction, which sounds awful.

更糟糕的名字。

Worse name.

我是说，如果你真的去看原始出版物，他们甚至没有称之为睡眠限制疗法。

I mean so so if you actually look to the original publication, they didn't they didn't even call it sleep restriction therapy.

他们称之为卧床时间限制，这才是它真正的含义。

They called it restriction of time in bed, which is really what it is.

这又是一个概念简单但执行困难的理论。

It's it's a simple concept of again, a lot of these things are simple in concept but difficult than execution.

但我不喜欢称之为睡眠限制疗法，因为这其实与限制无关。

But the concept of sleep restriction therapy, which I hate calling it that because it doesn't it's it's not about the restriction.

关键就在这里。

And that's the thing.

睡眠限制可能是其中的一部分，但并不总是如此。

Sleep restriction could be part of it, but it isn't always.

这个理念是说，假设你在床上躺了八小时，但只睡了六小时。

The idea is, let's say you're spending eight hours in bed, but six hours asleep.

我们知道你生理上能睡六小时。

We know you physically can sleep six hours.

好。

K.

那我就给你六小时的卧床时间。

Let me give you six hours time in bed.

看看你能不能充分利用它。

See if you can fill it.

我们会让你达到能充分利用这段时间的状态，然后再逐步延长时间。

Let's get you to the point where you can fill it, and then we'll slowly increase it from there.

实际上，睡眠限制疗法更多是增加睡眠而非减少。

Actually, sleep restriction therapy has more increasing of sleep than decreasing.

但一开始会有一个减少的阶段。

But there's that there's a decrease at first.

我是这样向人们解释的。

The way I explain it to people is this.

其实并不太复杂。

It's actually not super complicated.

假设你想让孩子吃蔬菜，但有个孩子不肯吃西兰花。

Let's say you're trying to eat your vegetables and you've got a kid who's not eating their broccoli.

对吧？

Right?

你在他们盘子里放了20朵西兰花，但他们就是不吃。

You put 20 pieces of broccoli on their plate and they're not eating.

他们能吃一两口，然后就开始抱怨，'哦，我讨厌西兰花'之类的。

They can eat one or two and then they're like, oh, I hate broccoli, blah blah blah.

然后你说，好吧。

Then you say, okay.

我需要你学会吃西兰花。

I need you to learn how to eat your broccoli.

今晚我会给你两朵西兰花。

Tonight, I'm gonna give you two pieces of broccoli.

我知道你能吃完的，因为你每天都吃这么多。

Can you I know you can eat that because that's what you've been eating every day.

我知道你能做到的。

I know you can eat that.

于是你吃完两朵西兰花，然后他们说，'但我还是饿'。

So you eat the two pieces of broccoli, and then they say, but I'm still hungry.

你就说，'很好'。

And you say, great.

明天你会得到三块。

You will get three tomorrow.

看看你能不能吃掉那些。

Let's see if you can eat those.

然后他们可以吃掉三块，但我还是饿。

Then they can eat the three pieces, but I'm still hungry.

就像是，好吧。

It's like, okay.

先别吃。

Hold off.

不要吃其他东西，但第二天你就会饿到能吃下四块。

Don't eat anything else, but the next day, you'll be hungry enough to eat four.

然后你慢慢从他们能做到的事开始，但你不给他们那些会让他们赖床的东西。

And then you slowly you start with what they can already do, but you don't give the other stuff that that will so you you don't let them stay in bed when they're not sleeping.

至少要给他们已经能够完成的机会。

At least give them the opportunity they're already able to fill.

起初，所有的心理障碍之类的东西都会存在。

At first, all the mental blocks and stuff will be there.

所以短期内可能会稍微减少他们的睡眠，持续几天，甚至可能长达几周。

So it might drive down their sleep a little bit in the short term for for several days, maybe even up to a couple weeks.

但最终他们会饿到足以吃掉盘子里所有的西兰花，因为你没有给他们其他食物。

But they eventually eventually, they get hungry enough where they can eat all the broccoli on their plate because you're not giving them anything else.

然后突然间，开始重新引入他们真正喜欢的其他食物，但他们已经克服了对西兰花的抵触。

Then all of a sudden, start introducing other foods back that they actually like, but they've gotten over their broccoli deal.

睡眠问题也是如此。

And that's what it is with sleep.

你增强了他们自然的睡眠压力。

You drive up their natural sleep pressure.

你将床上非清醒的时间区分开来。

You separate out the time in bed that's not wake.

通过增强这种自然的睡眠压力，你让人从无法入睡变成无法保持清醒。

You make it so that being in bed you're so you go from not being able to fall asleep to not being able to stay awake because you drive up that natural sleep pressure.

这就像，嗯，你食欲有问题吗？

And it's like, well, you have problems with your appetite?

稍微禁食一下。

Fast for a little bit.

这对解决很多食欲问题很有帮助。

That'll help a lot of problems with your appetite.

你会再次感到饥饿的。

You're gonna be hungry again.

所以不把手机带上床也是这个理念的一部分。

And so this idea of not having your phone in bed is part of that.

对。

Yeah.

这是其中的一部分，因为你不想在床上做任何与睡眠无关的事。

It's part of that because you don't wanna do anything in bed that is not sleep.

你要做到当你上床时，把头放在枕头上，盖好被子，闭上眼睛，用鼻子呼吸。

You want you want you wanna make it so that when you get into bed, you put your head on the pillow, you're under a blanket, your eyes are closed, you're breathing through your nose.

那种感觉如此可预测地与短时间内失去意识联系在一起，以至于当你熟练掌握后——这就是它的力量所在。

That that that feeling is so predictably tied with becoming unconscious in a very short amount of time that even when you get good at that so this is this is the power of this.

当你熟练掌握后，你不仅在利用这种预测来解决问题，更是在创造益处。

When you get good of that, you're using the prediction not just to solve a problem, but to create a benefit.

想象你有点压力。

Imagine you're a little bit stressed.

明天有个重要的日子。

You got a big day tomorrow.

但你已经训练自己，那个地方如此可预测地与睡眠相连——你有压力，明天很重要，手头有工作，但一躺下闭眼枕着枕头盖好被子开始呼吸，突然就睡着了。

But you've so trained yourself that that place is so predictably tied with sleep that you're stressed, you've got a big day, you've got stuff you're working on, you get into bed, close your eyes, head on pillow, under blankets, start breathing, then all of a sudden, you fall asleep.

你可以训练自己获得想要的结果，这让你掌握控制权。

You've you can you can train yourself to get the outcome you want, and that gives you control.

假设某天你需要特别早起，因为要去某个地方练习或做什么事。

So let's say you gotta wake up super early one day because you're you're you're going somewhere, you gotta practice or something.

你需要比平时提前一小时左右上床睡觉。

You need to go to bed an hour or so earlier than you really are used to.

如果你训练有素，就可以在需要时将环境作为睡眠的条件刺激。

If you've got yourself well trained, you can use the environment as a conditioned stimulus for sleep when you want it to be.

那么，对大多数人来说，通过刺激控制、睡眠限制来训练自己需要多长时间？比如床只用于睡眠和性行为这种说法。

So when so how long does it take to to for most people to train themselves, like, through the stimulus control, sleep restriction where, you know, the bed is really just for I've I've heard sleep and sex.

是的。

Yeah.

性行为没问题。

So sex is fine.

通常这不会造成困扰。

That's usually not the problem.

没错。

Right.

你知道，在床上、床外，任何地方都可以进行。

You know, do that in bed, out of bed, wherever you want.

这完全没问题。

That's fine.

通常来说，那不会占用太多时间。

Usually, that's not taking up so much time.

我是说，而且... 对。

I mean, and it Right.

它并不会干扰你的睡眠能力。

That it's and it's not interfering with your ability to sleep.

有时候它反而有助于睡眠，这没问题。

Sometimes it can help your ability to sleep, but that's fine.

但是

But

现在手机可能是最大的问题。

It's probably the phones that are the biggest problem nowadays.

是各种干扰因素。

It's it's distractions.

所以干扰、激活，所有这些事情，你是在增加能量而不是释放能量。

So distraction, the activation, all of this stuff, it's you're adding energy in instead of taking energy out.

在床上放松是可以的，但如果时间过长，比如你花半小时在床上冥想，可能就有点太久了。

Relaxation is fine to do in bed, but if it's brief, you know, if you're spending, you know, a half an hour meditating in bed, that might be a little too long.

我认识一些人，他们有整整一小时长的睡前仪式。

If you're I I've I've known people who, like, they they have this whole hour long routine that they do.

等到那一小时结束时，床已经不再必然与睡眠联系在一起了。

Like, by the time that hour is done, the bed is no longer predictably tied to sleep anymore.

所以，关键是要把这些习惯改掉。

So, yeah, it's about it's about getting this stuff out.

我不是说完全不能用手机。

It doesn't I'm not saying don't be on your phone.

但说实话，我觉得睡眠专家建议每个人睡前一小时别碰手机并不是个有用的建议，因为没人会照做。

But, I I mean, I actually think this the sleep field telling everyone get off their phone for an hour before going to bed is not a helpful recommendation because no one's gonna follow it.

我们应该讨论的是如何安全使用手机，而不让它影响睡眠。

We should be talking about how to do it safely in a way that's not gonna get in your way.

这就回到你之前说的，要么在另一个房间使用，要么...

And that comes down to what you were saying earlier, either being in another room or

是的。

Yeah.

坐起来或站着。

Sitting up or standing.

对。

Yeah.

而且，重要的是你在做什么。

And and, also, it's what you're doing that's important.

你可能需要设定一些界限。

You might wanna create sort of boundaries.

比如，在计划睡觉前半小时内，可以切换到不太刺激大脑的活动。

So, like, maybe within a half an hour of when you're planning on going to bed, maybe switch to something that's not too mentally activating.

如果你是那种看新闻会情绪激动的人，睡前就别看新闻了。

Like, if if you're the kind of person where you watch the news and it gets you all worked up and angry, don't do that before going to bed.

可以改在晚上早些时候看。

Maybe do it the hour, you know, in the in the earlier part of the evening.

我的意思是，现在的好处是电视不再是实时的了。

I mean, the great thing now is TV isn't live anymore.

在我小时候，你必须在节目播出时观看，仅此而已。

Back when I was a kid, you had to watch it when it was on, and that was it.

现在我们可以更好地控制自己接触媒体的内容。

Now we could watch we can we can gain more control over what we're exposing ourselves to media wise.

我使用的经验法则（这也是我给自己定的）：如果现在突然响起警报说‘好了’

The rule of thumb I use, and this is what I use for myself, if an alarm went off right now and said, okay.

该关掉了，我能做到吗？

Time to turn it off, could I?

如果答案是肯定的，那么在那个时间段做这件事可能没问题，因为我可以轻松抽身。

If the answer is yes, then it's probably okay to do within that time frame because I can easily disconnect from it.

如果答案是否定的

If the answer is, no.

不行

No.

不。

No.

再给我五分钟。

Five more minutes.

我想看看结局如何，或者我想...你懂的。

I wanna see how it ends or I wanna, you know, whatever.

那可能不是缓冲时段该看的内容。

That's probably not the thing to watch in that buffer time.

在缓冲时间之前观看，但不要在缓冲时段这么做。

Watch it before the buffer time, but don't do that in the buffer time.

比如，如果你在刷手机且能轻松放下，我不觉得这有什么大不了的。

Like, if you're scrolling and you can easily put it down, I don't know that I don't know that that's that big of a deal.

但如果你刷着刷着半小时就过去了还没察觉，白白浪费了时间。

But if you're scrolling and, like, half an hour will go by and you wouldn't even notice and you lose that time.

然后你还说自己没时间，其实你刚刚就扔掉了一些本不需要浪费的时间。

And then you say you don't have time, but you just threw away some time, you know, that you didn't need.

所以，这类事情就是这样的。

So, like, those are the sort of things.

你要确保精心安排自己的活动，避免过度刺激。

You wanna you wanna make sure that you curate what you're doing so that it's not too activated.

为什么很多失眠患者会被开具像安必恩这样的镇静剂？

Why are a lot of people that that have insomnia, why are they prescribed, you know, these sedatives like, you know, Ambien?

或者

Or

嗯，它们并非完全无效。

Well, they don't not work.

我的意思是，正如我所说，它们通过极大提升睡眠驱动力来压倒任何障碍，这是一种简单的解决方案。

I mean, like like I was saying, like, what they do is they drive up that sleep drive so much it overpowers whatever's in the way, and it's kind of an easy solution.

但说实话，开处方要容易得多。

The thing is, honestly, it's much easier to write a prescription.

随便去哪家基层医疗机构，他们都能开处方。

Like, you can go to any primary care anywhere, and they can write prescription.

但如果你查看所有对失眠治疗有建议的医疗机构

But if you if you look at every medical organization that has any recommendation around ins how to treat insomnia.

对于运动员来说，这包括NCAA和国际奥委会等发布过睡眠相关材料的机构

And for athletes, you know, this includes, like, NCAA and IOC who who've put out sleep related materials.

它们都首推认知行为疗法(CBTI)，因为所有研究数据汇总显示其效果出奇地好

They all say CBTI first, and that's because every study that has ever been done shows that when you compare, when you pool the data from CBTI trials, it works shockingly well.

不仅效果稳定可靠，甚至在慢性疼痛患者身上也有效

Not only does it work reliably well, it works when you have other like, well, what about if you're in chronic pain?

比如疼痛让你无法入睡时，这属于条件性觉醒还是活动性症状？

Like, the pain is keeping you up, how is that you don't have condition arousal, you have an active thing going on?

对纤维肌痛、慢性疼痛乃至癌症患者同样有效

Still works in works in fibromyalgia, works in chronic pain, works in cancers.

对癌症幸存者效果可能更好，因为他们不愿服用这些药物

It actually might be better in cancer survivors than people who aren't cancer survivors because they don't wanna take these medications.

他们的治疗动机更强

They're more motivated.

它对睡眠呼吸暂停也有效。

It works in sleep apnea.

甚至在治疗睡眠呼吸暂停之前就有效。

It works before your sleep apnea is even treated.

它有助于改善你的失眠。

It helps with your insomnia.

给我找个反例试试。

Find me a condition.

对老年人有效，对年轻人有效，就像一把钝器，无差别作用。

Works in older people, works in younger people, works in so, like, it it's a blunt instrument.

这是在重新训练你的睡眠能力。

It's retraining yourself to sleep.

它通过帮助人们重获掌控感而发挥显著效果。

It doesn't it it and it works well by helping people gain control.

虽然不一定会延长你的夜间睡眠时长，但安眠药同样做不到这一点。

It doesn't necessarily add hours to your night, but neither do sleeping pills either.

它的作用是消除其中一些障碍。

What it does is it removes some of those barriers.

但再次强调，大约85%的情况下有效，并非100%。

But, again, about 85% of the time, not a 100%.

但也有些人不知道如何获取它。

But it's also some people don't know how to get access to it.

或者他们在网上读到相关信息，要么获得的信息质量不佳，要么接触方式有问题——比如虽然按部就班操作，但可能还需要一些灵活性调整。

Or they read about it online and either the the information they get isn't isn't great or they have exposure to it in that, you know, maybe, you know, maybe they're doing it by the book, but they might need a little flexibility with it or something.

不过存在很多适应性方案。

But there's lots of adaptations.

我们甚至编纂过关于如何针对不同人群调整CBTI的教科书。

I mean, we edited a textbook on how to adapt CBTI to different populations.

但很多人根本不知道它的存在，而知道的人也不真正理解它是什么，或如何找到懂行的专业人士。

But, you know, a lot of people just don't know it exists, and the people who do don't really understand what it is or how to find someone who knows what they're doing.

这就是关键所在吗？

Is that the key?

你真的必须找专业人士指导吗？还是可以自己尝试？

Do you really have to find someone that knows what they're doing, or can you try this yourself?

两种情况都可以。

Yes and yes.

我是说，我接触过很多人都是自己尝试并实践的。

I mean, there are many people that I've talked to who've tried it, done it with themselves.

毕竟这不是什么高深莫测的科学。

I mean, because it's not rocket science.

虽然其中有些技巧，但基本原理相对简单。

The there's an art to it, but the the basics of it are relatively simple.

核心就是床等于睡眠。

It's bed equals sleep.

睡不着就离开床。

Get out of bed if you're not sleeping.

你要压缩自己的睡眠窗口，给自己太多机会反而不好。

You know, compress your window of of op you're giving yourself too much opportunity.

你没有充分利用它。

You're not filling it.

先压缩你的机会窗口，等能再填充时再扩大。

Compress your opportunity, but then expand it again once you can fill it.

一些像这样的基本原则。

Some basic stuff like that.

有些人可以自己做到这些，这就足够了。

And some people could just do that on their own, and that's all it takes.

有些人则需要专业人士指导。

Some people, they need somebody who knows what they're doing.

问题在于精通这方面的人并不多。

The problem is there's not a whole ton of people who are trained in this.

尽管这种方法历史悠久且证据充分，但训练有素的从业者仍然稀缺。

Despite its being around for a long time, despite the fact that it's really well supported, there's not a ton of people who are well trained.

现在有一些在线版本可以自动化某些环节。

There are some online versions available where they can automate some some aspect of this.

这是一个非常按部就班的过程，但对很多人来说，这就足够了。

It's a very it'll be very by the book, but for a lot of people, that's all it takes.

你可以通过远程医疗完成这个。

You can do this over telehealth.

无论你在哪个州，我向你保证你们州肯定有人能通过远程医疗提供这项服务。

Any state that you're in, I can promise you there's someone who can do this via telehealth in your state.

过去这项服务受地域限制很严重。

So it used to be very geographically restricted.

现在已经不是这样了。

It's not anymore.

网上有几个不错的目录可以查找专业人员，我们有专门的认证委员会。

There's a couple of good directories online of if you're looking for somebody, We have a board certification.

你可以查看谁获得了这方面的专业认证。

You could see who's board certified in this.

这个认证体系之所以存在，是因为它不属于常规培训内容。

And we and it exists because it's not part of normal training.

所以要能宣称自己擅长某件事，你必须证明自己确实懂行。

So to be able to say that you're good at, you have to, like, prove that you know what you're doing.

不过，是的，你可以在网上找人。

But, yeah, you can look online for people.

而且，再说一次，也有远程医疗的选择。

And, again, there's there's telehealth options too.

所以无论你在哪个州，都能找到合适的人选。

So whatever state you're in, you can find somebody.

美国人口中有多大比例患有失眠症？

What what percentage of, like, The US population has insomnia?

这是个很好的问题。

It's a great question.

几十年来，所有人口层面的研究基本上都发现了类似的结果，而且似乎没有太大变化——大约三分之一的美国人存在某种睡眠问题，无论是入睡困难、睡眠维持障碍还是睡醒后感觉没有恢复。

For decades, any population level study has generally found kinda the same thing mostly, and it hasn't doesn't seem to have mostly changed much, that about one out of three people in The US has some sort of sleep complaint or problem or something, whether it's falling asleep, staying asleep, not feeling refreshed.

这至少占了总人口的三分之一左右。

That seems to be about a third of the population at least.

如果进行评估的话，大约十分之一的人可能符合失眠障碍的标准。

And it seems like about one in ten people probably would meet the criteria for an insomnia disorder if you if you if you assess them.

然后他们开始尝试自己解决问题，走上了一些最终无济于事的道路，结果变得更加沮丧。

And then what ends up happening is they start trying to fix it on their own, and they start going down paths that end up being unhelpful, and then they get more frustrated.

接着睡眠变得更有压力，他们放弃了，并说，我是个没救的例子。

And then sleep becomes more stressful, and they give up, and they say, like, I'm a I'm a hopeless case.

我在诊所每周都会遇到一个这样的病例。

I get one of these a week in clinic.

我是你见过最糟糕的睡眠者。

So I'm the worst sleeper you've ever seen.

我已经尝试过所有方法了。

I've tried everything.

这个问题困扰我一辈子了。

I've had this problem forever.

经过六到八次治疗后情况会好转。

Then six to eight sessions are better.

是啊。

Yeah.

十分之一的比例相当高了。

I one in ten is a lot.

确实。

And Yeah.

你知道，我觉得我们肯定会讨论人们转而求助的那些物质，因为他们以为这能帮助解决睡眠问题，而他们甚至未必知道自己患的是失眠症。

You know, I definitely think we're gonna talk about some of these substances people then turn to because they think it's gonna help treat their sleep problem, which they don't necessarily know is even insomnia.

对吧？

Right?

所以他们就会求助于酒精之类的东西，而这些实际上并无帮助。

And so they're, you know, turning to things like alcohol, and and that doesn't really help.

不过在讨论那个之前，你刚才提到了睡眠呼吸暂停症。

So but let's before we get to that, sleep apnea you mentioned.

对。

Yeah.

这正是我想讨论的另一个话题。

And that's another one that I wanted to talk about.

我认识很多人似乎都有睡眠呼吸暂停的问题。

I've known a lot of people, it seems, that have had sleep apnea.

我想知道你能告诉我这种情况有多普遍。

I wonder how you can tell me how common that is as well.

但首先，我想先请教你，有哪些不太明显的症状表现呢？

But first, I kinda wanted to ask you, like, what are some of the non obvious presentations Yeah.

就是那些你可能观察到的睡眠呼吸暂停症状。

That, you know, of sleep apnea that you see Yeah.

特别是那些甚至没有报告过嗜睡症状的人？

Especially in people who, like, maybe don't even report feeling sleepy?

没错。

Right.

关于睡眠呼吸暂停，首先要了解的是它惊人的普遍性。

So so the thing with sleep apnea is the first thing to know about sleep apnea is it is shockingly common.

它非常、非常、非常普遍。

It is very, very, very common.

我见过的最新数据估计，大约每四到五位30岁男性中就有一位可能存在至少某种睡眠呼吸问题，特别是当他们的BMI超过30时，比例会上升到五五开。

The most recent data I've seen estimates that about one out of four or five men 30 probably has at least some sleep related breathing issues, especially if if their BMI is over 30, it's more like fifty fifty.

这个比例真的很高。

It's really high.

女性患病率较低，但在女性中同样惊人地普遍。

Women get it less often, but it's also shockingly common in women too.

女性中可能约每十五到二十人中就有一例。

It might be more like one out of every fifteen or twenty women.

随着BMI上升，患病率也会增加。

And then as as BMI goes up, it gets more common.

所以它确实普遍得惊人。

So it's it's shockingly common.

它如此常见，以至于我对筛查它的门槛设得非常低，尤其是对体型健康的人群，因为常规风险因素——比如体重增加时，患病率会上升，因为脂肪可能挤压呼吸道。

It's so common that my threshold for screening for it is very low, especially among otherwise fit people because the normal risk factors so, like, as you gain weight, it it it you get it more because it can crowd out your airway.

肌肉也是吗？

Muscle too?

是的。

Yeah.

肌肉也是。

Muscle too.

因为你可以这样想。

It's because think of it this way.

大多数哺乳动物的气道是一条直线，从口鼻部一直延伸到肺部。

So most mammals, their airway is a straight line, you know, from snout all the way up and and to to to their lungs.

从口鼻部到肺部是一条直线。

It's a straight line from snout to their lungs.

人类通过直立行走解决了很多问题，也从直立姿势中获得了很多好处。

Humans, by by moving upright, we solved a lot of problems, and and we've gotten a lot of benefit from being upright.

但这给我们带来了一个问题——现在我们的气道里有一个90度的弯折。

But we it created it created a problem with us in that our tube now has a 90 degree angle in it.

如果你设计管道时在软管上弄出一个90度的弯折，哪里会开始出现问题呢？

And if you're designing a pipe and you put a 90 degree angle kink in your hose, where is it where is it gonna start having problems?

问题就会出现在那个弯折处。

It's gonna have problems at that.

实际情况正是如此。

And that's what happens.

所以就在这个位置附近，我们的气道会变窄。

So, like, right around that spot here, that's where we get narrowing of the airway.

因此，任何组织——无论是肌肉、脂肪还是其他——任何组织都会造成影响。

And so, like, any mass, whether it's muscle or fat or whatever, any mass.

有些人会看MRI显示的舌脂肪、脸颊脂肪等，即使是较瘦的人，如果气道较窄，这个区域也会更受挤压。

I mean, there are people who look at MRIs of, like, tongue fat, like like, cheeks, like anything here that whether even skinnier people with smaller airways, you know, where it's a little more compressed.

这确实是人类生理结构在呼吸问题上的一个薄弱环节。

It just it it's it's a it's a vulnerability in in the human physiology for breathing issues.

实际上多数情况下还好，夜间每小时出现四五次呼吸暂停仍在正常范围内。

And it there it's actually mostly fine in that you can have four or five breathing pauses per hour in the night and be in the normal range.

实际上睡眠呼吸暂停在每小时5次时还不算轻度症状的开始

It's actually sleep apnea doesn't begin at five as mild.

轻度症状的下限是每小时5次，而要到每小时15次才会开始转为中度

Begins the low end of mild, and it's not even till you get to 15 per hour that it becomes start becoming moderate.

所以许多处于轻度范围的人甚至没有任何症状，可能不会造成任何问题

So many people who are in the mild range don't even have any symptoms and might not be causing any problems.

我们的身体系统其实有很大的适应能力

We have a lot of flexibility in the system.

但随着年龄增长和神经肌肉控制能力的变化，当我们因增重或其他原因给气道施加更多压力时，这种情况就会变得越来越普遍。

But as you get older and neuromuscular control changes, as we put on more pressure here in the airway by gaining weight or whatever, it just becomes more and more common.

我的猜测是，这种现象在历史上其实一直很常见。

And my guess is it's actually been common through history.

只是我们把它归咎于其他原因，尤其是在那些没有明显症状的人身上。

It's just we've written it off as something else, especially in people that don't have those obvious signs.

那么，有哪些不那么明显的症状呢？

So what are some of those less than obvious signs?

如果有个病人来看诊时说，我入睡完全没问题。

If I have a patient who comes in, and they say, I fall asleep just fine.

实际上，要说有什么的话，我白天有点疲倦。

Actually, if I'm anything, I'm a little tired during the day.

随便吧。

Whatever.

我入睡没问题，但半夜会因为压力醒来。

I fall asleep just fine, but then I wake up in the middle of the night because of stress.

我的压力让我醒来，然后就很难再入睡。

My stress wakes me up, and then I have a hard time falling back asleep.

当我听到这个，我认为有超过五成的几率是呼吸事件导致的。

When I hear that, I think there's greater than fifty fifty chance in my mind that that was a respiratory event.

压力不会让你醒来。

Stress doesn't wake you up.

实际情况是当你醒来想着'我压力好大'时，你的大脑正在解读信号，比如心率加快、呼吸频率上升、肌肉紧张导致的内啡肽变化。

What happens is if you wake up and you're thinking I'm stressed, your brain is reading signals like elevated heart rate, elevated respiratory rate, indoor the the the endorphins of the muscles getting tense.

它正在解读这些生理信号。

You're it's reading these physical signs.

而因为我们所处的社会环境，压力随时可得。

And then because we live in the society we live in, stress is readily available.

我们能迅速用压力填满那个空白。

We can fill that space really fast.

但真正唤醒你的并非压力本身。

But what what was happening was wasn't the stress that woke you up.

而是因为你的呼吸开始变得有些受限。

It was that, you know, your breathing was starting to get a little bit constrained.

于是你的呼吸道会试图自行扩张。

So then what happens is your airway tries to open itself up.

它努力尝试了，但并未成功。

And it was trying, and it wasn't it wasn't successful.

所以它就更用力地尝试。

So it tried harder.

仍然没有成功。

Still wasn't successful.

再努力一点尝试。

Tries a little harder.

依然没有成功。

Still not successful.

最坏的情况是你会自己醒来，可能会因为突然能呼吸而惊醒——毕竟醒着时呼吸完全没问题。

Worst case, you wake yourself up, and you and you can you can wake up with a gas because you can breathe when you're awake just fine.

这是不同的神经肌肉控制系统。

It's a different neuromuscular control system.

所以当你醒来时，会突然惊醒，因为那一小股肾上腺素让你醒了过来。

So as soon as you wake up, you sort of get that that sudden awakening because you just got that little sort of a shot of adrenaline to wake you up.

就像如果我在夜里给你注射一点肾上腺素，你就会醒来且无法再次入睡。

And, like, if I just shot you up with a little bit of adrenaline during the night, you'd wake up, and you would not be able to fall back asleep.

你的思绪会开始狂奔，并出现所有这些身体反应。

Your mind would start racing, and you'd have all these physical signs.

但唤醒你的并不是压力。

But it wasn't the stress that woke you up.

压力是后来叠加在上面的。

The stress got superimposed on it later.

所以当有病人来就诊时描述那种感觉：我半夜醒来，要么是因为压力，要么毫无缘由。

So when I have a patient who comes in and describes that sensation of I wake up in the middle of the night either because of stress or for no reason.

我不知道为什么。

I don't know why.

有什么东西把我惊醒了。

Something wakes me up.

我完全不明白，但我无法立刻重新入睡，比如在几分钟内。

I have no idea, but I cannot get right back to sleep immediately, like, within a few minutes.

我是说，刚刚肯定发生了什么事。

I mean, something just happened.

某个地方刚刚突然发作了。

Some flare up just happened somewhere.

这就是我所关注的。

That's that's what I look at.

对于运动员，我通常会关注的是他们感觉睡眠非常浅，却不知原因。

In athletes, often what I'll look at is I feel like my sleep is really shallow, and I don't know why.

因为实际情况可能是他们存在许多这种低水平的呼吸问题——这才是关键。

Because what's happening is you might be having lots of these low level respiratory that's the thing.

当你遇到更严重的睡眠呼吸暂停，比如每小时30次或更多事件伴随其他症状时，但很多轻中度病例出现在那些体重不超标、年纪不大且没有神经肌肉控制问题的人群中——这类问题通常随年龄增长出现。

When you get the more severe sleep apnea, like 30 events per hour or more with with these other presentations, but you get a lot of the mild to moderate cases in people who, you know, don't have a lot of extra weight, aren't older and have neuromuscular control issues, like, which just happens with age.

他们更年轻。

They're younger.

他们更健康，但可能只是气道较窄。

They're healthier, but they just might have a narrow airway.

所以我永远记得，

And and so, like, I'll never forget.

比如曾有位奥运级别的运动员与我合作。

Like, there was this there was an Olympic level athlete I was working with.

她当时正在参加选拔赛，她说自己没能达到预期的成绩。

She was she was in the trials, and she's like, she's not meeting the times I think I should.

她仍然比其他人都快，但她说直觉告诉她有什么东西阻碍了她发挥全部潜力。

She was still faster than everybody else, but she's like, my intuition is telling me something is in my way from reaching what I could be doing.

我不知道那是什么。

I don't know what it is.

然后我问，你睡眠怎么样？

And, like, how are you sleeping?

她说感觉自己的睡眠有点浅。

It's like, I feel like my sleep is kinda shallow.

入睡没问题，但总觉得夜里会醒几次，不确定这算不算问题。

I fall asleep just fine, but I feel like I'm up a few times during the night, and I don't really know if that's a problem or not.

所以我说，那我们来查查怎么回事吧。

So I'm like, well, let's see what's going on.

结果发现她有轻度睡眠呼吸暂停，治疗后情况好转了。

Turns out she had she had mild sleep apnea, got that treated better.

然后她说，哦，原来是这样。

And she's like, oh, that was it.

而在现实世界中，这很容易被忽视。

And and in the real world, it would have been missed.

可能就只是有人浑浑噩噩地度过一天。

It would have been someone just slogging through their day.

他们可能会想，唉，你知道的，生活真难。

They would have just been like, ugh, you know, life is hard.

我好累。

I'm tired.

睡眠质量不好。

Not sleeping is good.

如果她不是运动员的话，可能要等到三十年后症状更明显时才会被诊断出来。

And then probably in thirty years, she would have gotten diagnosed by the time it was more obvious if she weren't an athlete.

那么一个人应该怎么做呢？

So what should a person do?

比如，这种情况每晚都会发生吗？人们会因为睡眠呼吸暂停而频繁醒来？

Like, how many is this an every night thing where people are getting woken up, like, if they're having apnea?

这是每晚都会发生的情况吗？

Is this, like, an every night thing?

比如，在不去做那些检查的情况下，人们可以关注哪些症状群或生物标志物？

Like, what sort of sort of symptom clusters, biomarkers can people look at short of like going and getting the

对。

Yeah.

就是那种戴在手指上测血氧的设备，还有整套的...对。

Thing on your finger and measuring the oxygen and, you know, the whole Yeah.

我的意思是，事情是这样的。

I mean, so so here's the thing.

人们偶尔在半夜醒来是正常的。

It's normal for people to wake up in the middle of the night sometimes.

实际上，普通成年人每晚都会醒来10次甚至更多次。

Actually, the typical adult will wake up 10 times a night or more during the night.

他们只是不记得了。

They just don't remember.

时间非常短暂。

It's very short.

我是说，进化在很久以前就解决了这个问题。

I mean, again, evolution figured this out a long time ago.

你醒来，发现没有熊，就继续睡觉。

You wake up, no bear, back to sleep.

这很正常。

Like, that's normal.

但如果你能记住更多这样的清醒时刻——比如记得三四次醒来，特别是惊醒，比如突然喘着气醒来，或者带着鼾声醒来，或者总觉得睡眠不足。

But if you're remembering more of those awake if you're remembering three, four awakenings, if you have an awakening, especially waking up, like, with a gasp, like, if you wake up like that or you wake up with a snort to a if you wake up with something like that, if you if or if you feel like you just can't get enough sleep.

就像你试图多睡会儿，但无济于事。

Like, you try and sleep a little bit more, but it doesn't help.

这就像空有热量却毫无营养。

It's like it's just it's just empty calories.

你知道吗？

You know?

这已经和睡眠时长无关了。

Like, it's not about the amount anymore.

像是有什么东西人为地让睡眠变浅了。

There's, like, something that's keeping it artificially shallow.

可能的原因有很多。

There's lots of things it could be.

睡眠呼吸暂停实在太常见了。

It's just sleep apnea is so common.

为什么不做个检测呢？你干脆去检查一下吧？

Why not take test why don't you just get tested?

去拿个转诊单做个检测就行。

Just go get a referral, get tested.

现在在家就能做这些检测了。

You can do them at home now.

这很简单。

It's easy enough.

反过来看，目前还没有真正好的生物标志物。

In turn it's it's there's no real good biomarker for it yet.

我知道有人在研究这个。

I know people are working on it.

除了睡眠浅之外，没有真正好的生物标志物。

There's no real good biomarker except that that sleep is shallow.

睡眠是碎片化的，而你却不知道原因。

It's fragmented, and you don't know why.

我是说，可能是其他原因。

I mean, it could be something else.

可能是炎症。

Could be inflammation.

可能是疼痛。

It could be pain.

可能是环境因素导致的。

It could be environmental.

可能性有很多。

There's lots of things.

就像如果你无法呼吸，是肺部有问题吗？

It's like if if you're not breathing, is there a problem with your lungs?

是气道有问题还是空气污染的问题？

Is there a problem with your airways or problem with the pollution in the air?

所以，是不是有什么东西阻碍了你的身体入睡？

So, like, is it is there something that's preventing your body from being able to sleep?

而且如果是睡眠呼吸暂停，这太常见了。

Or and and and if it is sleep apnea, it's so common.

这就是为什么我对筛查的门槛设得极低——因为如果真是这个原因，我跟你试了所有建议，做了各种努力，你还是觉得‘唉，就是睡不好’。

This is why my threshold for screening is just ultra low because if it was that and I do all the tips with you and I work out this and I do all this And you're still feeling like, ugh, but my sleep just isn't good.

如果我第一天就知道这可能是原因却没去检查，我会觉得自己像个白痴。

And I knew on day one that this was a possible reason why, then I'd feel like an idiot for not even checking.

因为我们做了这么多工作，可能根本没必要。

Because I we did all this work, and maybe we didn't even need to.

那些家用设备吗？我记得多年前在读研究生时做过一次，当时可能是因为压力大而醒来。

Do those at home kind because I remember doing one once, like, years ago when I was in graduate school, I was I think I was waking up because of stress.

嗯。

But Yeah.

对。

Yeah.

检测结果是阴性，但我戴了这个，嗯...

The test came out negative, but I wore this, like Yeah.

好像是血氧监测仪之类的。

Ox pulse thing, I think.

记不清具体是什么了，戴在手指上的。

I don't know what it on my finger.

所以现在市面上有很多这类设备。

So so there's there's a bunch of devices.

这些年来它们变得更先进也更小巧了。

They've gotten better and smaller over the years.

仍有一些人需要来实验室做检测。

There's still people who do need to come into the lab.

这些通常保留给同时存在其他睡眠障碍的情况，比如嗜睡症、肢体运动障碍等。

Those are usually reserved for when there's, like, another sleep disorder you're also looking for, like narcolepsy or or or limb movements or something.

或者如果你有复杂医疗状况，比如需要吸氧，或可能有心力衰竭等需要住院监护以确保安全的情况。

Or if you're medically complicated, like you need supplemental oxygen, or if you might have heart failure or something where you need to kinda be monitored in the hospital while you're doing it for safety.

除此之外，或者你在家做的检测呈阴性但仍有大量症状，可能是检测遗漏了。

Other than that or or the test you did at home was negative, but you still have a lot of symptoms and maybe it missed it.

因为家用检测设备的灵敏度不够高。

Because the the home tests aren't as sensitive.

比如它不会出现假阳性暂停，但可能出现假阴性结果。

Like, there you'll you won't get false pauses, but you might get false negatives.

大多数情况下只有这些情况才真正需要来实验室检测。

That's the only time you'd really need to come into the lab most of the time.

通常，他们只会给你设备带回家使用。

Usually, they just give you the thing to take home.

现在你可以把它当作腕带佩戴。

And these days, you can wear it as a strap.

有些设备只需戴在手腕上，就能监测你夜间的血氧水平。

They have ones that just go on your wrist, and they measure they measure your oxygen levels during the night.

你能看到的是你的呼吸如何与血氧水平相关联。

And what you can see is how is your respiration tied with your o two?

因为夜间呼吸频率会下降，血氧水平也会略微降低。

Because respiration drops during the night too, and so does o two a little bit.

但如果你的呼吸频率下降后血氧开始降低，之后又回升恢复，通过观察这些夜间模式，一个晚上就能判断某人是否明显患有睡眠呼吸暂停。

But if if your respiration is dropping and then your o two starts dipping and then it then opens back up again and gets recovered, like, you just look at these patterns of what's happening during the night, and you can see in one night if someone's clearly has sleep apnea or not.

好的。

Okay.

这很简单。

It's easy enough.

如果你正在与患有阻塞性睡眠呼吸暂停的人合作，比如，你如何区分这是由过敏、体位性因素还是像鼻塞之类的问题引起的。

If if you're working with someone who has obstructive sleep apnea, like, how do you go about differentiating if it's, like, caused by allergies or positional or, you know, something something like nasal congestion.

我不知道。

I don't know.

嗯，对。

Like Yeah.

是的。

Yeah.

当症状处于轻度到中度时。

When it's more on the mild to moderate side.

没错。

Right.

这种腕带设备的好处在于它们通常内置陀螺仪，可以分别测量你侧卧和平躺时的呼吸状态。

Where so the great thing is the the the ones that are on the strap, they usually have a gyroscope in it, and they can measure your breathing separately on your side and on your back.

很多人只是平躺时才会出现这种情况。

There's a lot of people where it's just that it's on their back.

问题就在这里。

That's the issue.

对这些人来说，其实有非常简单的解决方法。

And for those people, there's actually really simple fixes.

你可以设置他们出售的这些设备，其实就是一条佩戴的带子。

You can set they sell these devices where the truly just a strap you wear.

以前人们会在T恤背面缝个网球，原理就是这样。

In the old days, they used to sew a tennis ball on the back of a t shirt, that's all it is.

所以当你翻身压到它时，就会自然翻回来。

So, like, whenever you rolled on it, you just roll off it.

现在他们有各种高级版本，本质上还是这个原理，就是一条带子。

And they have, like, fancy versions of that now where that's essentially what it is, where it's there's one there's a couple of where it's a strap.

就像腰带一样，但腰带背面有个小凸起。

It's like a belt, but, like, the back of the belt has a little bump on it.

所以当你翻身压到它时，就会自然翻回来。

And so, like, whenever you roll on it, you just roll off it.

它就是能让你不仰卧睡觉。

It just stays off your back.

就这么简单。

That's it.

你无法在睡着时强迫自己不仰卧。

You can't force yourself to stay off your back when you're asleep.

你可能会想：我要侧着睡。

You're like, well, I'm gonna fall asleep on my side.

但当你无意识时是控制不了的。

Well, you can't control it when you're unconscious.

所以在诊断时很容易判断是否是体位性问题。

So, like, you can see if it's positional easily in the diagnosis.

如果是的话，就尝试用体位疗法来治疗。

And if it is, then just try and treat it positionally.

之后我会用体位矫正装置重新测试，看看症状是否全部消失。

And then what I would do is retest using the positional device and see if it all goes away.

因为它可能有效，也可能无效。

Because it might, might not.

如果是过敏问题，这就是为什么睡眠医生——你知道，我们接受了很多培训，我在轮转睡眠医学时也接触过这些。

If it's allergies, this is why the the the sleep docs, you know, we get a lot they get a lot of training, and and and I've gotten some of this too when I rotated in sleep medicine.

比如，你会知道要观察什么。

Like, you see what to look for.

所以，你要观察鼻孔，看他们的鼻子，让他们吸气，检查口腔内的气道，可以看到软腭的位置、舌头的状态，这些都能观察到。

So, like, you look at nostrils, you look at their nose, you have them breathe in, you look inside the airway in the mouth, and and, like, you can see where their soft palate is, you could see their tongue, you could you can see some of these things.

要知道，有时候很多睡眠药物会使用像Flonase这类东西来清理鼻腔。

And, you know, sometimes, you know, there's a lot of sleep medicine that's using, you know, Flonase and and some of the stuff to sort of clear up the nose.

但请记住，阻塞几乎总是发生在你气道后方这个90度转角处。

But remember, the obstructions almost all the time are back here in that 90 degree angle in your airway.

并不是像人们以为的打鼾是鼻子问题那样。

It's not up it's like people think snoring is is a nose based thing.

其实根本不是。

It really isn't.

有时你会遇到像是松弛的鼻孔之类的情况，但几乎完全是因为问题出在后方。

Sometimes you get, like, sort of floppy nostrils or whatever, but almost entirely, it's the the issue's back here.

是你的舌根部位。

It's the back of your tongue.

这也是为什么仰卧时情况往往更糟，因为重力会把组织往后拉。

That's also why on your back, it's worse often because gravity starts pulling stuff back.

或者当你张嘴时，舌头后坠可能阻塞气道。

Or, like, when you open your mouth and your tongue falls back and can block the airway.

所以你去睡眠科就诊时，医生可以在体检时做这些检查。

So so that's so, like, you can do that in the physical exam when you go to the sleep doc.

他们可以检查你的口腔和鼻腔，就能发现问题所在。

They can take a take a look at your mouth and take a look at your nose, and and they'll be able to see.

但我得告诉你，这种情况实际上只占极少数病例。

But I'll but I'll tell you, it is a vast, vast minority of the time where that's actually the cause.

人们希望是这个原因，因为这样更容易解决，但通常并非如此。

People want it to be because it's an easier fix, but, that's usually not it.

如果有人患有未经治疗的睡眠呼吸暂停会怎样？

It it what happens if someone has untreated sleep apnea?

那么，我的意思是，他们的睡眠结构会有什么变化？

So, I mean, what what happens to their sleep architecture?

我是说，首先也许我们应该简单提一下睡眠阶段，但它会影响睡眠结构吗？

I mean, first of all, maybe we should briefly mention, like, the sleep stages, but, like, does it affect their sleep architecture?

不同的睡眠阶段是这样的。

So so here's the different sleep stages.

当你入睡时，会进入第一阶段。

Stage so when you fall asleep, you enter stage one.

第一阶段是极其浅度的睡眠。

Stage one is super ultra light sleep.

就像你打瞌睡时有人突然敲桌子，你会惊醒问'那是什么'的状态

If you are sort of, like, nod off and someone bangs the table and you're like, what what was that?

那就是第一阶段。

That's stage one.