身体健康与双相情感障碍：如何生活得更好更久

双相情感障碍患者更容易面临哪些风险？

Is there anything that people with bipolar disorder are at greater risk for?

很多方面。

Lots of things.

我的意思是，是的，你患双相情感障碍的风险会更高。

I mean, yes, you are going to be at greater risk for bipolar disorder.

你会

You are going to

等一下。

Wait.

等一下。

Wait.

你刚才说双相情感障碍患者会 Yeah。

Did you just say that people with bipolar disorder are Yeah.

为什么？

Because what?

患有双相情感障碍的人。

People bipolar disorder.

让我先说一下。

Let me start off.

让我先说一下。

Let let me start off.

拜托。

Come on.

拜托。

Come on.

不。

No.

不。

No.

我想保留这段。

I wanna leave this in.

我想看到我们总是保留我的错误，却从不保留你的错误。

I wanna see every we always leave my mistakes in, but we never leave your mistakes

好吧，我会犯和你一样多的错误，这样就公平了。

Well, I'll make as many as you, so there we go.

您正在收听《内在双相情感障碍》，这是Healthline Media出品的播客，我们通过真实案例和最新研究来探讨双相情感障碍。

You're listening to Inside Bipolar, a Healthline Media podcast where we tackle bipolar disorder using real world examples and the latest research.

大家好，欢迎收听本节目。

Hey, everybody, and welcome to the podcast.

我叫加比·霍华德，患有双相情感障碍。

My name is Gabe Howard, I live with bipolar disorder.

我是医生。

And I'm Doctor.

妮可·华盛顿，一位认证精神科医生。

Nicole Washington, a board certified psychiatrist.

今天我们将努力解答这个问题：由于我患有双相情感障碍，我应该警惕哪些身体症状，并请医生格外关注？

And today we are going to work very hard to answer the question, what physical symptoms should I be on guard for and ask my doctor to keep a closer than usual eye on because I live with bipolar disorder?

我知道这听起来是个繁琐的问题，但我们的邮箱里经常收到这样的提问。

And I know that sounds like a cumbersome question, but it shows up in our email boxes a lot.

所有症状。

All of them.

本期结束。

End of episode.

留意所有事情。

Look for everything.

所有那些方面。

All the stuff.

一切。

Everything.

要时刻关注你的身体。

Just be be on guard about your body.

但说真的，盖布，我认为仅仅因为你患有双相情感障碍，并不是原因所在。

But seriously, I I do, Gabe, think that just because you live with bipolar disorder, that isn't the reason why.

我的意思是，我们每个人都有一个身体。

I mean, we all have one body.

如果我们幸运的话，这个身体会伴随我们很长时间，所以我们需要好好照顾它。

And if we're fortunate, we have it for a long time and we need to take care of it.

但我觉得我们并不总是做得很好。

And I don't think we always do that great a job.

当你被诊断出像双相情感障碍这样的疾病时，很容易把所有精力都投入到管理你的双相障碍上，而忘记了我们每个人都需要应对的那些日常事务。

Now when you are then diagnosed with an illness like bipolar disorder, I think it's easy to put so much effort into managing your bipolar illness that you forget about just the regular stuff that we all have to deal with.

我喜欢你选择了医生的回答，对吧？

I love that you went with the doctor answer, right?

定期做体检，控制体重，做化验，关注你的身体，因为这是你唯一的载体，你需要它来过好生活，不管你有没有双相情感障碍都一样。

Get yearly physicals, you know, manage your weight, get lab work, pay attention to your body because it's your only vessel and you need it to live well, and it doesn't matter if you have bipolar disorder or not.

我喜欢这一点，但我们现在不能结束这一集，因为赞助商可能会生气。

I love that, but we can't end the episode now because the sponsors would get mad.

我们需要再延长一点内容，我得告诉你，根据我们收到的邮件，人们在问一些非常具体的问题，比如：因为我患有双相情感障碍，我得糖尿病的概率会不会比常人更高？

We need to have more of an episode, and I got to tell you, judging by the emails that we get, people are asking very specific questions like, Because I live with bipolar disorder, do I have a greater than usual chance of getting diabetes?

另一个我们收到的问题是：因为我患有双相情感障碍并服用药物，我会出现肝功能问题吗？

Or another question that we had was, because I live with bipolar disorder and take medications, will I have liver function issues?

虽然我完全同意你的观点，我们都应该每年做体检，都该有一位全科医生。

So while I completely agree with you, we all need to be getting physicals every year, we all need to have a general practitioner.

我们都应该密切关注自己的健康。

We all need to pay close attention to our health.

身体和心理健康。

Physical, mental health.

是的。

Yes.

你患糖尿病的风险更高。

You have a higher risk of diabetes.

患睡眠呼吸暂停的风险也更高。

There's a higher risk of sleep apnea.

许多我们通常担心的躯体健康问题，你的风险也更高。

There's a higher risk of a lot of physical health conditions that we worry about anyway.

其中一些与药物有关。

Some of it is medication related.

其中一些与生活方式有关。

Some of it is lifestyle related.

还有一些原因我们尚不明确，但患有双相情感障碍等疾病时，某些疾病的患病风险会增加。

Some of it, we don't really know why, but there are increased risk of certain diseases when you live with an illness like bipolar disorder.

好的。

All right.

医生，我们就直白地解释一下吧。

Let's just go ahead and and and explain this like plain as day, Doctor.

妮可。

Nicole.

深入详细地给我讲讲，让我能真正理解。

Like like like dig deep and explain it to me so that I can understand it.

双相情感障碍会导致糖尿病吗？

Does bipolar disorder cause diabetes?

双相情感障碍会导致任何身体疾病吗，还是说只是药物或生活方式的改变在背后起作用，而这些又可能是由双相情感障碍引起的？

Can bipolar disorder cause any physical illness, or is it just taking meds or just lifestyle changes that maybe the bipolar disorder is driving?

我知道我在啰嗦，因为我真的在挣扎，不知道该怎么表达。

I know I'm rambling because I'm I'm I'm just I'm just struggling.

双相情感障碍能像引发躁狂或抑郁一样，直接导致身体疾病吗？

Can bipolar disorder cause a physical illness in the exact same way that bipolar disorder can lead to mania or depression?

双相情感障碍会导致糖尿病或高血压吗？

Can bipolar disorder lead to diabetes or high blood pressure?

不是那种方式。

Not in that way.

我们知道抑郁和躁狂是这种疾病的一部分。

We know that depression and mania are are part of the disorder.

我们没有任何数据表明，患有双相情感障碍的人就一定会在某个年龄前心脏病发作，或者一定会患上糖尿病。

We don't have any data to suggest that if you have bipolar disorder, that what comes with that is heart attacks by a certain age or you'll absolutely develop diabetes.

我认为我们有很多信息支持药物可能起作用，生活方式也可能起作用。

I think we have a lot of information to support that medication could play a part, lifestyle can play a part.

有些人本来就有着这些疾病的强烈家族史。

Some people have strong family histories of these disorders anyway.

当你再把药物带来的问题和生活方式的因素加在一起时，这就变成了多因素共同作用的结果。

And then when you add in the trouble from the medication in addition to the lifestyle part, it's multifactorial.

但我们没有任何证据表明，仅仅因为患有双相情感障碍，就一定会出现这些问题。

But we have nothing to say that just because you live with bipolar disorder, you absolutely will have any of these things.

我有一个具体的问题，尼科尔医生，我知道我服用治疗双相情感障碍的药物，并且每半年做一次血液检查。

One of the specific questions that I have, doctor Nicole, is, you know, I take medicine for bipolar disorder, and I get, bi yearly labs.

所以一年两次，他们会抽血，检查肝功能、维生素缺乏等情况。

So so twice a year, they they they take blood, and they say that they're doing things like liver function tests, vitamin deficiency, and things like that.

显然，因为我服用治疗双相情感障碍的药物，我更容易出现肝脏问题或维生素缺乏。

So clearly, because I take medication for bipolar disorder, I am at higher risks for liver issues or to be vitamin deficient.

听到这些时，我有一部分想法是：糟了，这意味着这些药很危险，我不该吃。

Now there's a part of me that hears that and thinks, uh-oh, that means these medicines are dangerous and I shouldn't take them.

但另一部分我又明白，没错，解决办法就是：预防胜于治疗。

But there's another part of me that hears, well, right, but the the solution is, you know, an ounce of prevention is worth a pound of cures.

是的。

Yeah.

我的意思是，实际上我并不喜欢做化验。

I mean, actually, I don't enjoy getting lab work done.

我不喜欢抽血。

I I don't enjoy having my blood drawn.

我不喜欢这些事情中的任何一项，但我还是会做，因为为了维持我希望的健康水平，我必须做。

I don't enjoy any of those things, but I do them because I need to do them in order to maintain the level of health that I want to maintain.

所以我认为最好的起点是肝脏。

So I think a great place to start is the liver.

当我们说要检查你的肝功能时，人们总是非常恐慌，因为他们无法理解为什么我们会给你可能损害肝脏的东西。

People are always very freaked out when we say we're going to check your liver functioning because they can't understand why in the world would we give you something that could mess up your liver.

事实上，你服用的大多数药物，即使是非处方药，大多数都是在肝脏中代谢的。

Well, the reality is most of the medications that you take, even over the counter medications, most of them are metabolized in your liver.

所以，如果你正在服用治疗双相情感障碍的药物，或者治疗偏头痛、糖尿病或其他任何疾病的药物，你的肝脏都在承担大量工作。

So if you are taking medication for bipolar disorder, if you're taking medication for migraines and diabetes and any other illness that you may have, your liver is putting in a lot of work.

有些药物对肝脏的负担比其他药物更重。

There are some medications that are more taxing on the liver than others.

有一些特定的精神健康药物对肝脏的负担比其他药物更重。

There are some specific mental health medications that can be more taxing on the liver than others.

所以我们才要进行检查。

So that's why we're checking.

另一个问题是，如果某种药物对你有效，但可能对肝脏造成负担，我认为这并不意味着我们就不能使用它。

The other thing is we we have to have some hard decisions about if they work well for you and they have a risk of being hard on the liver, I I don't think that means we don't do it.

我认为我们进行检查的原因就在这里。

I think that's why we're checking.

我们进行检查是为了确保不会造成任何损害。

We're checking because we want to make sure that we're not doing any kind of damage.

我想快速谈谈房间里最大的问题，那就是药物的副作用可能非常令人担忧且具有破坏性。

I quickly want to address the elephant in the room, which is that the side effects of medications can be very alarming and very damaging.

如果我们回顾历史，比如迟发性运动障碍和精神分裂症。

And if we look historically, let's take tardive dyskinesia and schizophrenia.

许多人认为，来回摇晃、舌头在口中进出、不受控制的动作是精神分裂症的症状，但实际上这些是药物的副作用。

Many people think that rocking back and forth, your tongue darting in and out of your mouth, uncontrolled movements are a symptom of schizophrenia when they're actually a side effect of the medication.

所以我不希望任何人听到后认为：‘你不必认真对待药物的副作用。’

So I don't want anybody to hear, Oh, you don't need to take the side effects of medication seriously.

你需要非常认真地对待这些副作用。

You need to take them very seriously.

这就是为什么实验室检查和血液检测非常重要。

That's why things like labs and blood work are very, very important.

但我经常想到过山车。

But I think a lot about roller coasters.

我知道这听起来很奇怪，但我非常喜欢过山车。

And I know that's weird, but I love roller coasters.

我非常热爱过山车，但我小时候很焦虑，也很害怕。

I absolutely adore roller coasters, but I was an anxious child, and I was afraid.

我害怕在过山车上受伤。

I was afraid that I'd get hurt on roller coasters.

我现在来自一个热爱过山车的家庭。

Now I come from a family of people who love roller coasters.

我的祖父是一位电气工程师，也是个完美主义者，思维非常工程化，他问我：‘你怕什么？’

And my grandfather, who was an electrical engineer and a perfectionist and thought very engineer wise, he said, What are you afraid of?

我说：‘因为太高了，我怕会受伤。’

And I said, Well, it's really, really high up, and I'm afraid I'll get hurt.

他问：‘你怎么会受伤？’

And he's like, How would you get hurt?

我说：‘万一整个东西倒了怎么办？’

And I was like, Well, what if the whole thing falls over?

我祖父说：‘这没什么问题。',

And my grandfather said, Oh, that's no problem.

每天早上，他们都会检查过山车。

Every morning, they inspect the roller coaster.

我说：‘真的吗？’

I said, Really?

他说，是的。

He said, Yes.

我祖父这个人从不撒谎，也不开玩笑，等等。

Now my grandfather, he doesn't lie, he doesn't joke, etcetera.

但他表示，每天早上他们都会检查过山车，确保它安全。

But said that every morning they check out the roller coaster and they make sure it's safe.

我本可以轻易地想：既然这么安全，为什么还要检查呢？

Now I could have easily heard why do they need to check it if it's so safe?

但我听到的是，他们是在双重确认它是否安全，现在我可以安心乘坐了。

But what I heard is they're double checking to make sure it's safe, and now I can ride with impunity.

对。

Yeah.

每六个月、每年、每三个月或任何其他频率的检查，都是安全规程。

The checking every six months or every year or every three months or whatever that looks like, that's the safety protocol.

这些措施就是为了确保你的肝脏不会发生变化。

That that's what's in place to make sure that you're not having changes in your liver.

当我们考虑肝脏健康时，还得想想其他因素，比如你是不是经常大量饮酒？

And then we have to think of other things when we think about liver health, you know, are you someone who's drinking alcohol, you know, in great amounts?

酒精对肝脏的伤害可能非常严重。

Alcohol can be very, very rough on the liver.

肝脏真的非常重要。

The liver is just really so important.

我知道肝脏很重要，否则当我说‘我们来查一下你的肝酶’时，人们不会这么紧张。

And I know we know it's important because otherwise people wouldn't get freaked out when I say, hey, let's check your liver enzymes.

他们根本不会在意。

They wouldn't bat an eye.

这很重要。

It's important.

非常重要。

It's very important.

你 definitely 应该问问医生：我的药物会不会对肝脏造成负面影响？

And it is definitely something that you should be asking your doctor about, Do my medications affect my liver negatively?

我们有没有检查过我的肝功能，看看它运作得怎么样？

Have we ever checked my liver functions to see how things are working?

这些问题问得非常好。

Those are fantastic questions for you to ask.

医生，我只是出于好奇问一下。

Now, just out of curiosity, Doctor.

妮可，这是属于灾难性故障的情况，还是说你会提前得到很多预警？

Nicole, is this a catastrophic failure situation or do you get a lot of notice?

比如，在我的过山车类比中，他们关注的是缺失的木板、裂缝、松动的螺丝、轨道问题等等。

For example, in my roller coaster analogy, one of the things they're looking for are missing boards, cracks, loose screws, track issues, etcetera.

因为他们不希望过山车突然垮掉。

Because what they don't want is for the thing to just fall over.

他们希望看到磨损迹象，以便及时维修，确保安全。

They want to see signs of wear and tear they need to repair to keep it safe.

当你做血液检查并查看肝脏指标时，会不会出现这种情况：哦，我们发现了个问题，但没什么大不了的。

When you do this blood work and look at the liver, are you like, Oh, hey, we've noticed an issue, but it's no big deal.

到目前为止，我们发现得很早，你不需要恐慌。

We've caught it so far in advance, you don't need to panic.

还是说这是一种‘你很好，你很好，你很好’的情况？

Or is this a situation of you're fine, you're fine, you're fine.

天啊，不，出了大问题。

Oh shit, no, there's a huge problem.

你明白我在说什么吗？

Do do you understand what I'm saying?

因为我也明白，你让别人感到困惑了。

Because I I get what you're confuses people as well.

是的。

Yes.

我们正在关注某些血液指标，一些与你肝功能相关的数值，看看自上次化验以来这些数值是否有所上升。

There are certain blood levels that we're looking at, certain numbers that we're looking at as far as your liver functioning, and we're looking to see if they've risen since the last time we did lab.

你知道吗，有什么变化了吗？

You know, has something changed?

也许我们在过去几个月里加了新的药物。

Maybe we added a new medication in the last few months.

突然间，我们注意到这些数值开始略有上升。

And now all of a sudden, we noticed that those numbers are starting to creep up a little bit.

我们总是将它们与你的基础值以及之前的检测结果进行比较。

We're just comparing them always to your baseline and comparing them to the previous results.

但关键是，这就像找到一颗松动的螺丝或一块破损的木板。

But the point is is it's sort of like finding that loose screw or that that broken board.

只要拧紧螺丝，换掉破损的木板，过山车就没事了。

Just tighten up the screw, replace the broken board, and the roller coaster's fine.

负责每日检查的结构工程师不会惊慌失措地说：天哪。

No no structural engineer doing the daily check freaks out and says, oh my god.

过去24小时内乘坐过这东西的所有人都处于危险之中。

Everybody who's ridden this thing in the last twenty four hours has been in harm's way.

没有。

No.

他们只是把它当作常规维护来处理并加以修复。

They just look at it as routine maintenance and fix it.

所以你不需要对这个肝酶检测提心吊胆。

So you don't need to be waiting on pins and needles for this liver enzyme test.

我觉得你确实不必提心吊胆。

I don't think you need to be waiting on pins and needles.

我从不告诉你任何事情都是百分之百的，但我们关注的总是这种非常微小的波动。

I would never tell you that anything is always a 100%, but it's always this very small jump that we're looking for.

我不能保证绝对没有极端案例，比如有人对某种东西产生极端反应。

I can't tell you that there wouldn't be some some extreme case out there where somebody had an extreme reaction to something.

但我可以告诉你，这种情况并不常见，这也正是我们如此频繁地检测这些数值的原因。

I can tell you that's not the norm, and I can tell you that's why we check the values as often as we do.

现在另一个我常听到的问题是关于维生素缺乏。

Now another thing that I hear is about vitamin deficiency.

说实话，我对这个问题持两种看法。

And, you know, I'm of two minds here.

对吧？

Right?

从医学的角度来看，我觉得这些药物可能导致维生素缺乏，而我们需要维生素来保持健康强壮。

There's the medical mind where I was like, Hey, these medications can cause vitamin deficiency, and we need vitamins to be big and strong.

但另一方面，我会想到那些患有双相情感障碍、正在应对抑郁的典型人群，以及我们吃的垃圾食品。

But I'm of the other mind where I think about the stereotypical person living with bipolar disorder, managing depression, and the junk food that we eat.

我就拿自己当例子吧。

And I'm just going use myself as an example.

尤其是我抑郁的时候，我吃的全是披萨、汉堡、多力多滋、薯片和冰淇淋。

Especially when I was depressed, I was eating nothing but pizza, burgers, Doritos, potato chips, ice cream.

全是垃圾食品。

It was all junk food.

是的，他们当时正用药物帮我稳定情绪。

And yes, they were trying to stabilize me with medications.

但我的饮食一团糟。

My diet was garbage.

我根本没有锻炼。

I wasn't getting any exercise.

然后他们做了个维生素检测。

And then they do a vitamin.

他们检查我是否缺乏维生素，结果我确实缺乏。

They check to see if I'm vitamin deficient, and I am.

我第一反应是：唉，这药让我缺乏维生素了。

And the first thing that I say is, Ugh, that medication is making me vitamin deficient.

患有双相情感障碍的人更容易缺乏维生素吗？还是说，正在服药的双相情感障碍患者更容易缺乏维生素？

Are people with bipolar disorder at higher risk for vitamin deficiency, or is it people with bipolar disorder who are taking medication are at a higher risk?

或者第三个可能性：吃垃圾食品的人更容易缺乏维生素，而我们都知道，许多心理健康问题患者饮食状况普遍不佳，所以你的精神科医生是在提前预防这个问题。

Or even a third option, people who eat garbage are at risk to be vitamin deficient, and we happen to know that a lot of people suffering from mental health challenges tend not to have the best diet, so your psychiatrist is trying to get ahead of it.

很大程度上，是饮食的问题。

Largely, it's the diet piece.

主要就是这个因素。

Largely, that is the factor.

有一些治疗双相情感障碍的药物，我们认为会影响某些维生素水平。

There are some bipolar medications, that we think have the ability to affect certain vitamin levels.

但总体而言，还是饮食问题。

But by and large, it's diet.

是营养问题。

It's nutrition.

是我们日常通过食物摄入不足的东西。

It's what we're not taking in on a regular basis through the foods we eat.

我们的许多维生素缺乏都源于此。

That's where a lot of our vitamin deficiencies are coming from.

这些维生素很重要，因为维生素缺乏会导致疲劳，而我们在抑郁症患者中经常看到这种症状。

And they're important because the vitamin deficiency can then lead you to have fatigue, which is something that we see a lot with people with depression.

对吧？

Right?

所以我可能会遇到一些人说，我真的好累。

And so I might have somebody who's saying, you know, I'm just so tired.

我总是感到疲惫。

I'm tired all the time.

尽管我的情绪已经好很多了，我也确实感觉好多了，但我还是一直非常疲惫。

And even though my mood is really better and I really do feel better, I'm just still so tired all the time.

这时候，我们可能会开始评估这些方面，看看是否有其他可以帮到你的问题。

That's when we may start going and evaluating those types of things to see if there's something else going on that we can help you with.

让我感到非常震撼的一件事是，几年前，在我从事倡导工作的早期阶段——那已经是十五到二十年前了，有一项具有里程碑意义的研究指出，患有严重且持续性精神疾病的人（其中就包括双相情感障碍）比普通人群的寿命短25年。

One of the things that was really fascinating to me is several years ago, near near the beginning of my advocacy career, so we really are going back fifteen, twenty years, there was this landmark study that came out that said that people managing severe and persistent mental illness, of which bipolar disorder was listed, die twenty five years younger than the rest of the population.

作为一个双相情感障碍患者，这个发现深深刺痛了我。

And as somebody living with bipolar disorder, this thumped my chest hard.

我的天，整整25年啊。

Mean, hurt like twenty five years.

我会失去我生命中的25年。

I'm gonna lose twenty five years of my life.

我的预期寿命是76岁。

My lifespan is 76.

我会在51岁去世。

I'm gonna die at 51.

这太可怕了。

That's horrific.

我真的很伤心。

I was really upset.

现在我很幸运。

Now I'm really lucky.

我最好的朋友是一位受过训练的物理学家，她懂得如何阅读研究论文。

My best friend is a trained physicist, and she knows how to read studies.

所以她能直接读懂整个研究，而不仅仅是新闻文章和宣传要点。

So she immediately gets the whole study, not just the news articles and the talking points.

她通读了整篇研究，然后说：好吧。

She reads the whole study, and she goes, okay.

我有个非常好的消息要告诉你。

I've got I've got really good news for you.

现实是这样的。

Here's the reality.

患有严重且持续性精神疾病的人更有可能吸烟、饮食不良、缺乏锻炼、做出高风险的生活选择，因此他们可能会比普通人早去世二十五年。

People with serious and persistent mental illness are much more likely to smoke, eat poorly, not exercise, make risky lifestyle decisions, and because of that, they are likely to die twenty five years sooner.

但关键是，如果你患有严重且持续性精神疾病，但饮食健康、坚持锻炼、定期体检、不做出高风险决定，那么你的寿命和其他人一样。

But here's the thing, if you live with serious and persistent mental illness, and you have a good diet, good exercise, you get your lab work, you're not making risky decisions, you have the same lifespan as everyone else.

所以我觉得我们正在讨论的一些事情有点像这样。

So I feel like some of the stuff that we're talking about is sort of like that.

是的，这里确实存在一些风险，但开车也有风险。

Yeah, there's some risk here, but there's risk in driving a car.

对。

Yes.

对。

Yes.

而风险并不是说‘我患有双相情感障碍’。

And the risk is not, oh, I have bipolar disorder.

哦，我得吃这些该死的药，现在我的维生素D又要低了。

Oh, I have to take this stupid medicine, and now my vitamin d is gonna be low.

这并不是我们正在讨论的内容。

That that's that's not what we're what we're talking about.

大部分情况下，正如你的朋友指出的，这种疾病夺走了你很多东西。

For the most part, what we're saying, just like your friend pointed out, the illness takes away a lot of things from you.

我的意思是，管理起来真的很困难。

I mean, it's it's tough to manage.

管理双相情感障碍需要耗费大量精力。

There's a lot of energy that goes into managing your bipolar disorder.

当你把这么多精力投入到管理双相情感障碍，担心症状和住院等问题时，

And when you're putting so much energy into managing your bipolar disorder and worried about symptoms and hospitalization and that kind

有时候你就不会去想锻炼和饮食，也不会去想我今天吃了多少绿叶蔬菜？

of stuff,

有时候你就不会去想锻炼和饮食，也不会去想我今天吃了多少绿叶蔬菜？

sometimes you're not thinking about exercise and diet and, oh, how how many leafy greens am I putting on my plate?

你有时候能吃上饭就已经很幸运了。

You're just lucky to eat sometimes.

只要能把食物吃到嘴里，那天就算成功了。

Just if I get food in my mouth, it is a win for that day.

从心理上来说，简单一点有时反而更好。

Easy is sometimes better for you mentally.

但从身体上来说，简单可能并不更好。

Easy may not be better for you physically.

这其中涉及很多因素，但你说得完全正确。

So there there's a lot of pieces that go into that, but that is a 100% right.

我在为这期节目做研究时感到非常着迷，也很期待和你聊聊，医生。

I've been very fascinated in doing research for this episode, and I've been excited to talk to you about this, Doctor.

妮可，因为我发现，许多对双相情感障碍患者造成伤害的因素，正如我在笔记中所称的，是‘双相相关’的问题。

Nicole, because I'm really finding out that many of the things that are hurting people with bipolar disorder are sort of what I've referred to in my notes as bipolar adjacent.

例如，双相情感障碍患者更有可能吸烟。

So for example, people with bipolar disorder are more likely to smoke.

吸烟者更容易患上肺癌。

Smokers are more likely to have lung cancer.

因此，事实上，双相障碍患者更容易患上肺癌。

So the ipso facto, people with bipolar disorder are more likely to have lung cancer.

我并不是主动发现的，而是偶然了解到的——我本人患有双相障碍，这一点大家都知道，而且我还有睡眠呼吸暂停。

And I came up, or not came up with, I stumbled upon, I live with bipolar disorder, as everybody knows, and I have sleep apnea.

我发现一项统计数据表明，双相障碍患者患睡眠呼吸暂停的可能性高出百分之五十。

And I discovered a stat that said people with bipolar disorder are fifty percent more likely to have sleep apnea.

但随后我又发现另一项数据：双相障碍患者更容易肥胖，而我们知道，超重或肥胖的人更容易患睡眠呼吸暂停。

But then I uncovered another stat that said that people with bipolar disorder are more likely to be obese, and we know that people who are overweight, obese, are more likely to have sleep apnea.

所以，我并不认为是双相障碍本身导致了睡眠呼吸暂停的增加。

So once again, I don't necessarily think it's the bipolar disorder that is driving the rise in sleep apnea.

现在我要明确一点，这些都是加布·霍华德的研究成果。

And now I want be very clear, this is Gabe Howard's research.

接下来我们将知道，我这样的理解是否正确，或者医生妮可尔是否接受过医学训练，即将纠正我刚才说的一切。

We're about to find out if I am conceptualizing this correctly or if doctor Nicole went to medical school and is about to correct everything that I just said.

加布，你并没有错。

Gabe, you're you're not wrong.

你完全没错，你不需要是医生也能明白这一点，你确实没有错。

You are absolutely not wrong, and you don't have to be a medical doctor to to to figure that out, that you are not wrong.

百分之百准确的是，患有双相情感障碍的人可能更容易超重，无论是因为药物、生活方式，还是其他任何原因，但这都会影响睡眠呼吸暂停。

It is a 100% accurate that people who have bipolar disorder may be at more risk of being overweight, whether that's because of medication, whether that's because of lifestyle, that whatever that looks like, but that can affect sleep apnea.

我认为从这一点中要记住的重要事情是，好吧。

I think the important thing to take away from this is, okay.

多达一半的双相情感障碍患者可能患有睡眠呼吸暂停。

So up to half of people with bipolar disorder could have sleep apnea.

我有吗？

Do I have it?

我需要评估一下，这是否是我正在面对的问题？

Like, I I need to evaluate, is that something I'm dealing with?

问题是，你怎么知道？

The question is how do you know?

所以，这对我来说总是特别有趣的一个话题。

So so this is always this is always a really fun one for me to talk about.

在某些方面有趣，在其他方面则不然，但总体上对我来说还是挺有趣的。

Fun in some ways, not fun in other ways, but mostly fun for me.

我认为睡眠呼吸暂停对很多人来说是一个被严重忽视的问题。

I think sleep apnea is highly overlooked as a problem for a lot of people.

我认为有很多人表现出与睡眠呼吸暂停一致的症状，却因为害怕做睡眠监测而选择忽视它们。

I think there are a lot of people out there who have signs and symptoms consistent with sleep apnea, and they are ignoring them because they are terrified of having a sleep study.

他们害怕有人盯着他们睡觉。

They are terrified of having someone watch them sleep.

我真的很难理解，我真的对这一点感到很困惑。

And I really struggle with with I really do struggle with that.

我甚至不会对你撒谎。

I'm not even gonna lie to you.

当全科医生跟他们谈起睡眠监测时，人们往往会感到非常不适。

People get so weirded out when their primary care doctor starts talking to them about a sleep study.

我真的不明白为什么。

And I I don't really understand why.

我的意思是，你做睡眠监测的时候紧张吗？

I mean, were you were you nervous about your sleep study when you had to get it?

我的意思是，有点吧。

I mean, sort of.

我一开始并不害怕做睡眠监测，但当我到了那里时，我还年轻，二十出头，一位非常漂亮的护士给我贴所有电极，然后她还给我戴了个麦克风。

I was not scared to get the sleep study at first, but when I got there, I was younger, I was in my early 20s, this very attractive nurse was putting all the electrodes on me, and then she put a microphone on me.

我问：这个麦克风是干什么用的？

I said, What's the microphone for?

她说：我们需要检查你是否打鼾。

And she said, Well, we need to check to see if you're snoring.

我第一反应是：它能听到我放屁吗？

And the first thing I thought is, Is it going to hear me fart?

我知道这有点幼稚之类的，但无论如何，这成了我真正的顾虑。

And I know there's an immaturity there, etcetera, but nevertheless, it became this real concern.

那会发生什么？

Like what happens?

然后我如果不申请许可就无法起床，所以我得按这个按钮，才能让人帮我解开设备，以便半夜去上厕所。

And then I can't get out of bed without asking permission, so I'm going to have to hit this button to get assistance to be unhooked so that I can go to the bathroom in the middle of the night.

我不喜欢跟陌生人讨论我的如厕习惯，但把这些都抛开吧。

I don't like to discuss my bathroom routine with strangers, but forget about all of that.

当我偏执、焦虑、抑郁、害怕的时候，躺在一个房间里，被一群人盯着看，简直就像噩梦一样。

When I was paranoid, when I was anxious, when I was depressed, when I was scared, being in a room with a bunch of people staring at me was kind of the thing of nightmares.

陌生人正在看着你睡觉。

Strangers are watching you sleep.

那里的人有的经历着精神病、偏执、焦虑和抑郁。

Here were people who are experiencing psychosis, paranoia, anxiety, depression

是的。

Yes.

可能会因此感到困扰。

Might be bothered by that.

是的。

Yeah.

好的。

Okay.

是的。

Yes.

但我不会让一个正在经历精神病发作的人去进行睡眠研究。

But I would not be asking someone who is actively psychotic to go do a sleep study.

这是针对那些状态相对稳定的人提出的请求，我们只是想微调一些细节，并且发现了一个可能的生理健康问题，希望加以解决。

This is an ask of someone who's in a fairly stable place, and we're trying to fine tune some things, and we've picked up on a potential medical physical issue that we want to address.

我明白。

And I get it.

我不希望有陌生人在一旁看着我睡觉。

I don't want random strangers watching me sleep.

谁会愿意呢？

Who does?

这太诡异了。

That is creepy.

然而，这些是医疗专业人员，而不是随机盯着我睡觉的陌生人。

However, these are medical professionals, not random strangers watching me sleep.

他们是医疗专业人员。

They're medical professionals.

他们只是在履行自己的职责。

They're doing their job.

这和在医生面前脱衣服，或者去做乳腺X光检查时让乳腺技师查看你的乳房没什么不同。

It's no different than having to get undressed in front of a doctor or having to pull your boobs out when you go get a mammogram with the mammogram tech.

这和那些事情没有任何区别。

It it's it's no different than any of those things.

所以，你知道，我不愿意随便向陌生人展示我的乳房，但你知道吗？

So, yeah, you know, I don't wanna randomly show my boobs to strangers, but you know what?

每年我都会向那位乳腺X光技师展示，让她检查并确保我在做乳腺X光时乳房是正常的。

Every year, I'm gonna show it to that mammogram tech so she can check and help make sure that my breasts are cleared when I go get my mammogram.

所以是的。

So yeah.

我的意思是，如果你从这些是医疗专业人士、而不是随机陌生人的角度去想，也许你得不断对自己重复这个观念，但这些人真的不是随便什么人。

I mean, I I think if you think about it in terms of these are medical professionals, these are not random strangers, maybe that's the mantra you have to keep saying to yourself, but but but these are they're not just random people.

他们不是陌生人。

They're not randos.

这是他们的工作。

It's their job.

我在被诊断出双相情感障碍之前，就已经被诊断出睡眠呼吸暂停了。

I was diagnosed with sleep apnea before I was diagnosed with bipolar disorder.

如果一个人患有双相情感障碍，并且知道自身有更高的睡眠呼吸暂停风险，那么他们应该留意哪些症状呢？

What are some symptoms that people should be looking for if they're living with bipolar disorder knowing that they have this elevated risk of sleep apnea?

大家好。

Hey, everyone.

我是盖布·霍华德，《内心健康》播客的主持人，这是Healthline出品的一档获奖周播节目，旨在通俗易懂地解析心理健康与心理学领域的复杂话题。

I'm Gabe Howard, host of the Inside Mental Health Podcast, an award winning weekly show from Healthline that breaks down complex topics around the world of mental health and psychology.

跟着我，向你能理解的专家学习，确保内容不会变成枯燥的学术讲座。

Learn from experts you can understand with me as your guide to ensure it doesn't devolve into a boring academic lecture.

我们涵盖所有与心理健康相关的内容。

We cover everything mental health.

所以请选择你感兴趣的剧集，并记住，了解你的内心是迈向更健康自我的第一步。

So pick the episodes that interest you and remember, understanding your mind is the first step to a healthier you.

在你最喜欢的播客平台上订阅并收听《内心健康》。

Subscribe and listen to Inside Mental Health on your favorite podcast platform.

我们继续讨论双相情感障碍是否会增加你的身体健康风险。

And we're back discussing if bipolar disorder increases your physical health risks.

人们自然会想，哦，你打鼾吗？或者你是个打鼾的人？

People automatically think, oh, do you snore or are you a snorer?

这是人们与睡眠呼吸暂停联系最紧密的特征。

It it is the big thing that people associate with sleep apnea.

让我觉得很好笑的是，有那么多独自睡觉的人来找我，告诉我：‘嗯，我不打鼾。’

And it's really funny to me how many people will come to me who sleep alone and they tell me, well, I mean, I don't snore.

于是我问：那你怎么知道呢？

And I I ask, well, how do you know?

你一个人睡。

You sleep by yourself.

然后他们突然恍然大悟：哦，原来我不知道自己晚上会不会打鼾，因为没人告诉我。

And and then they all of a sudden have this light bulb moment like, oh, guess I don't know if I snore at night because nobody's there to tell me.

所以如果你是和别人一起睡，问问他们你晚上的呼吸情况，问问你有没有打鼾。

So if you do sleep with someone, ask them about your breathing at night, ask them about your snoring.

很多时候，伴侣会说：嘿。

A lot of times, partners will say, hey.

我觉得他或她有睡眠呼吸暂停。

I think he or she has sleep apnea.

他们打鼾打得特别响。

They'll be snoring, snoring, snoring so loud.

然后突然间，我能听到他们在夜里努力吸气，或者有时发现他们呼吸停止了。

And then all of a sudden I can hear them kind of can hear them kind of try to catch their breath at night or I can hear them stop breathing sometimes.

有时候，是伴侣首先提出这个问题的。

Sometimes the partners are the ones who bring it up.

如果你没有和别人一起睡觉，还有哪些其他情况呢？

If you don't have a partner that you sleep with, what other things are going on?

你是否感到异常疲倦？

Do you have an unusual amount of fatigue?

这其实很棘手，因为当你同时患有伴随抑郁的疾病时，这种疲劳是抑郁引起的吗？

And that's really tricky because when you also live with an illness that comes with depression, is that fatigue your depression?

这种疲劳是其他原因造成的吗？

Is that fatigue something else?

是因为你超重吗？

Is it the fact that you're overweight?

是因为维生素缺乏吗？

Is it a vitamin deficiency?

因此，作为一名精神科医生，我总是建议我的所有患者都建立与全科医生的关系，因为我认为每年有一个人全面观察你的健康状况，帮助你评估这些身体上的健康问题，是非常有价值的。

So that's why as a psychiatrist, I'm always recommending that all of my patients have a relationship with a primary care doctor because I think it's valuable that you have somebody who's seeing you annually to help you evaluate those physical health concerns that you have.

如果你说，你知道吗？我特别担心。

I'm especially concerned if you say, you know what?

我的情绪确实好很多了，但我就是一直特别累。

My mood really is much better, but man, I am so tired all the time.

如果你白天会无缘无故地睡着，那就是一个明显的信号。

If you are falling asleep randomly during the day, that's a big sign.

如果你下午三点坐在那儿都看不下去一集电视剧，如果在办公桌前睡着了，或者在红灯或停车标志前睡着了，这些对我们来说都是非常令人担忧的迹象，可能提示你正在经历睡眠呼吸暂停。

If you can't sit and watch a TV show at 03:00 in the afternoon, if you're falling asleep at your desk, if you are falling asleep at red lights or stop signs, those are things that are very, very concerning to us and might tip-off that you might be dealing with some sleep apnea.

很多人想把这归因于双相情感障碍，无论是症状本身还是药物引起的，这确实有可能。

And so many people want to attribute that to bipolar disorder, whether it's the symptoms of bipolar disorder or the medication, which it could be.

有可能。

Could be.

但这样当然会让你忽略其他问题。

But of course, it it it makes you overlook something.

是的。

Yes.

因为如果你手里拿着一把锤子，看什么都像钉子。

Because if if you're holding a hammer, everything looks like a nail.

但对。

But Yes.

谁还存在？

Who still exists?

问题是，未经控制的睡眠呼吸暂停会加剧情绪波动、脑雾，让你更疲惫，更容易烦躁。

And the problem with that is uncontrolled sleep apnea can then add to mood swings, brain fog, make you more tired, could be more irritable.

如果不按应有的方式治疗睡眠呼吸暂停，还会增加你患其他疾病的风险，比如心脏病和肺病。

It can increase your risk of other diseases, other heart diseases and lung diseases by not having your sleep apnea treated as you should.

所以这简直是个恶性循环。

So it's it's really a dog chasing its tail.

我们有时搞不清楚到底是什么导致了什么，谁在影响谁，这里到底发生了什么，但这就是为什么你需要一个完整的团队，因为未经治疗的睡眠呼吸暂停会让控制双相情感障碍变得更加困难。

We sometimes don't know, okay, what what's causing what, who's going after, what's going on here, but that's why you need a whole team because having untreated sleep apnea can then make getting control of your bipolar disorder that much more difficult.

医生。

Doctor.