最常回放的时刻：体重增加与睡眠之间的联系！睡眠追踪器有害还是有益？

你之前提到过，人如果睡不够，肥胖和体重增加的风险就会升高。

You mentioned earlier that when people don't get enough sleep, the chance of obesity and weight gain increases.

对。

Mhmm.

这到底是怎么发生的呢？

How how does that happen?

背后的机制是什么？

What's the mechanism?

可能有多种原因，但其中一个比较清楚的是，当我们睡眠不足，或者因为其他原因比如睡眠呼吸暂停而被打断时，体内调节食欲和饱腹感的激素水平会发生变化。

So there are probably many mechanisms, but one of the ones that is best understood is that we know that when you're sleep deprived or indeed when your sleep is disrupted by anything else, like, for example, sleep apnea, there are changes that occur in terms of hormone levels of of hormones that regulate our appetite and our satiety.

哪怕只是缺觉一晚，也会导致夜间热量摄入大幅增加。

And so even a single night of sleep deprivation can result in a dramatic increase in your calorie intake overnight.

比如，已经有研究针对护士群体做过调查。

There have been some studies done, for example, in nurses.

有一项研究追踪了护士们十八年，观察了他们的体重和日常睡眠时间。

So there was a study done that followed up nurses for eighteen years, and they looked at their weight and how much they slept on a regular basis.

他们发现，那些每晚睡眠不足六小时的护士，一开始在十八年研究开始时体重就略高一些。

And what they found is that those nurses that were sleeping less than about six hours a night on a regular basis, first of all, started off at the beginning of that eighteen year period at a slightly higher weight.

但在接下来的十八年里，他们的体重增长远超其他群体。

But over the course of those sixteen years, eighteen years, they put on much more weight than other groups.

因此，睡眠时长和睡眠质量与体重增加之间有着非常明确的关联。

So there is a very clear correlation between sleep duration, sleep quality, and weight gain.

比如，在接受睡眠呼吸暂停治疗的人群中，我们也能看到这种现象。

We see that, for example, in individuals who we treat with sleep apnea.

治疗睡眠呼吸暂停的一种方法是佩戴一种面罩装置，防止夜间气道塌陷。

So one of the treatment for sleep apnea is a mask like device that you wear that stops your airway from closing down at night.

对于一些严重超重的人，一旦治疗了睡眠呼吸暂停，他们竟然成功减了重——而过去他们一直觉得这根本不可能做到。

And for some very overweight individuals, actually, when you treat their sleep apnea, they do manage to successfully lose weight, where in the past they found it absolutely impossible to do so.

明白了。

Okay.

所以如果我睡得不够，第二天就更可能吃下更多热量。

So if I'm under slept, I'm more likely to eat more calories the next day.

对。

Yes.

我是不是也更容易去吃那些高糖、不健康的食物？

Am I also more likely to to reach for foods that are like high in sugar and bad for

没错。

me?

确实，有些研究也支持这个观点。

Certainly, some studies do suggest that.

我觉得还有一点很重要，那就是睡眠不足或者睡眠质量差会对身体产生一些根本性的影响，比如影响你的葡萄糖耐量。

I think it's also important to say that sleep disruption or sleep deprivation have some fundamental effects, for example, on your glucose tolerance.

这会导致胰岛素抵抗，这当然是糖尿病患者特别关心的问题，但其实它会影响我们所有人。

So your insulin resistance, which of course, is a particular issue for people with diabetes, but it affects us all.

所以如果你严重缺觉，不仅食欲或者你想吃的东西会发生变化，你身体处理分解这些食物的方式也会跟着改变。

So if you're very sleep deprived, there are changes to the way that not only your appetite or what you're reaching for, but also how your body processes the breakdown of those food stuffs.

挺有意思的。

Interesting.

因为我个人觉得，只要我睡得不够，就特别容易想吃高糖的东西。

Because I anecdotally, I think I can I can clearly say that if I'm if I'm underslept, I'm much more likely to eat something that is high in sugar or

嗯，是那种对我有好处的食物吗？

Well, I think it's something good for me?

这种事谁没经历过呢？

We can all testify to that, can't we?

你想想，谁没在特别困的时候，心里想着：算了，就吃一块巧克力吧，对吧？

You know, I think everybody has known that situation where they're very sleep deprived and they think, oh, well, I I just need a bit of chocolate or Mhmm.

你懂的。

You know?

那大脑里到底发生了什么？

What what what's going on in the brain there?

为什么会这样？

What why is that?

这跟杏仁核和前额叶皮层有关吗？就是我们大脑里负责情绪的那部分

Is it is it something to do with the amygdala and the prefrontal cortex, the, like, emotional center of our brain in the

是的。

Yeah.

我觉得我们还不清楚。

I I don't I don't think we know.

我猜这跟支配我们行为的奖励机制有关，睡眠不足会改变我们追求的奖励方式。

I think it's probably to do with the reward mechanisms that underlie our our behaviors, that, there is something about sleep deprivation that alters the rewards that we're seeking.

但我没法给你一个明确的答案。

But I don't think I can give you a clear answer on that.

你之前还提到过生物钟。

You you also talked about circadian rhythms.

如果我是个十岁孩子，我该怎样理解生物钟呢？

If I if I was a 10 year old, what do I need to understand about the circadian rhythm?

它是什么，有什么作用，为什么重要？

What it is, what it does, and why it's important?

我们身体的几乎每个细胞里，都存在一个二十四小时的生物钟。

So within pretty much every cell of our bodies, there is this twenty four hour clock.

事实上，如果你把一个单独的细胞放在培养皿里，大约百分之四十的基因都会表现出这种二十四小时的周期性。

And in fact, if you take a single cell and stick it in a petri dish, about 40% of the genes within that cell will exhibit this sort of twenty four hour cycle.

这个二十四小时的周期几乎控制着我们身体里的每一个生理系统，比如肝脏怎么工作、心脏怎么工作、肺怎么工作。

And that twenty four hour cycle really controls pretty much every biological system within our bodies, be it how our liver works, how our heart works, how our lungs work.

大脑里有一个叫视交叉上核的区域，被认为是主时钟。

There is one particular area of the brain called the suprachiasmatic nucleus that is viewed as the master clock.

它是协调身体里所有其他时钟的总指挥。

It's the clock that coordinates all the other clocks within our bodies.

它不仅影响着遍布全身细胞里的这些时钟，也影响着我们的行为。

And that influences not only all of these other clocks that are occurring within the cells throughout our bodies, but influences our behavior as well.

比如，它决定我们什么时候感到疲倦、该上床睡觉、什么时候醒来，还影响我们什么时候精神最清醒、什么时候想吃饭、想喝水、或者最适合应对工作的时候。

So influences, generally speaking, when we feel tired and when we want to go to bed, and when we wake up, and also influences things like, you know, when we feel most mentally alert, when we want to eat, when we want to drink, when we feel most able to cope with work, for example.

对大多数人来说，这个生物钟会让成年人在晚上十点到午夜之间感到困倦、早上六点到八点之间醒来。

Now that circadian rhythm, that circadian clock for most people, confers the sleep onset of somewhere between 10PM and midnight if you're an adult and waking up somewhere between six and 8AM.

而这个生物钟的运行时间主要由两件事决定。

Now the timing of that body clock is governed by two things.

这由我们的基因决定。

It's governed by our genetics.

也就是说，有些人天生就比较晚睡晚起，有些人则天生早睡早起。

So whether or not we are genetically predetermined to be slightly later in terms of our body clock or slightly earlier.

在一些家庭里，很多人都是这样：我一向睡得晚、起得晚，我爸爸、我爷爷也都是这样。

And we see that in families where lots of people with, for example, will say, well, I've always gone to bed late and woken up late, but so as my father, so as my grandfather, etcetera, etcetera.

但环境因素也会产生影响。

But it's also influenced by what's happening in our environment.

我们生物钟的调控因素中，大约有一半来自外界环境。

About 50% of the definers of our circadian clock are governed by what's going on around us.

比如我们什么时候接触光线。

Be that in terms of when we're exposed to light.

我们知道，光线对生物节律影响很大，还有吃饭、运动，以及其他各种活动的时间也都很关键。

So we know that light is a very important driver of our circadian rhythm when we're eating, when we're exercising, when we're doing a whole range of other activities.

此外，褪黑素的分泌也是生物节律的一个重要标志。

And also, one of the markers of our circadian rhythm is the secretion of melatonin.

大脑中央有一个很小的腺体，叫松果体，它会分泌一种叫褪黑素的激素。

So there's a very small gland in the center of our brains called the pineal gland, which secretes a hormone called melatonin.

这种激素在大多数人身上通常晚上六点左右开始分泌。

That hormone tends to start being secreted in most people at around 06:00 in the evening.

它在我们想睡觉的时候达到高峰，然后在醒来前几个小时开始下降。

It peaks at the time that we want to go to sleep, and then it starts dropping down a few hours before we wake up.

这几乎是标记我们生物钟的一个化学信号。

It's almost a chemical marker of our circadian rhythm.

但我们也知道，通过口服褪黑素片剂，可以影响人的生物钟。

But we also know that giving people melatonin in tablet form, for example, can influence our circadian rhythm.

我们的身体自身分泌的褪黑素，和大脑里的主时钟——视交叉上核，之间存在一个反馈回路。

So there's this sort of feedback loop between our own body's secretion of melatonin and what our suprachiasmatic nucleus, our master clock, is doing.

所以，如果在特定时间服用褪黑素，就能把你的生物钟往前或往后调整。

So by giving people melatonin at particular times of the day, we can shift your circadian rhythm forward or or back.

那么大脑里的这个主时钟，具体在什么位置？

So that master clock in the brain, where is it positioned?

视交叉上核位于大脑一个叫下丘脑的小区域里。

The suprachiasmatic nucleus is in a small area of the brain called the the hypothalamus.

那和眼睛有关系吗？

And is that linked to the eye?

眼睛后部和下丘脑之间是有神经连接的。

There are links from the back of the eye to the hypothalamus.

眼睛后部视网膜里有一些细胞，它们不参与视觉成像，也不参与有意识的视觉感知。

So there are some cells in the back of the eye in the retina that are not involved in vision, not involved in conscious vision.

它们的作用是探测蓝光，而蓝光是调节我们生物钟最重要的那部分光线。

But what they are involved with is detecting blue light in particular, which is the part of the spectrum of light that is most important in terms of regulating our circadian clock.

这些被称为视网膜神经节细胞的细胞，和视交叉上核之间有直接的神经通路。

And there are direct links between these cells that are called retinal ganglion cells and the suprachiasmatic nucleus.

所以，尤其是接触蓝光，对强化或调整我们的生物钟非常关键。

So exposure to light to blue light in particular is really very important in reinforcing or adjusting our circadian rhythm.

当然，我们生活在一个四季更替、光照时长不断变化的世界里。

Now, of course, we live in a in a world whereby the seasons change and the amount of light that we're exposed to changes.

如果我们一直保持一个固定不变、无法调整的节律，那就可能出现生物钟和外界环境不匹配的情况。

So if we were on a set rhythm all the time, that was immovable and unadjustable, then there would be times where our circadian rhythm might not be might might be at odds with our environment.

所以生物钟需要做一些轻微的调整，而光线可能是最重要的调节因素。

So there does need to be some slight adjustment of that circadian rhythm, and light is probably the most important adjuster.

蓝光。

Blue light.

就是我手机发出的那种光吗？

Is that the light that comes from my smartphone?

蓝光最强烈的来源当然是太阳。

So it's so blue light, obviously, the strongest source of blue light is sun.

对。

Yeah.

不过，像你手机、平板电脑这类电子设备，确实也发出蓝光。

But yes, these kinds of devices, your smartphone, your iPad in front of you, a range of electronic devices also have blue light within them.

所以这就是为什么，如果我凌晨一点还在刷手机，盯着屏幕，其实是在误导视觉神经，进而干扰我的生物钟，让它误以为现在不是该睡觉的时间。

So so that's why if I'm if I'm up on my phone till 1AM in the morning, staring into the screen, I'm kind of tricking that sort of optic nerve, which is then impacting my master clock, and I'm I'm telling it that it's a different time.

是的。

Yeah.

不过这几年，人们对这个问题的看法有了一些变化。

So so the thinking on that has changed a little bit over over the last few years.

以前常说，使用这些设备会因为蓝光而引发失眠。

So it, you know, it was said that using these devices will trigger insomnia as of as a result of blue light.

但实际上，这些设备发出的蓝光量很可能不足以直接导致失眠。

Actually, it's likely that the amount of blue light that these devices put out is probably insufficient to do that directly.

不过，熬夜到凌晨一点玩电子设备，会有两个影响。

But there are two effects of using your gadget until 1AM.

第一个是长期来看。

The first is on a on a long term basis.

如果你经常这样，你的生物钟会逐渐推迟。

If you're doing that regularly, it will result in an adjustment of your circadian clock and push it back.

你会越来越想晚点睡、晚点起，如果你是自由职业者，或者时间上没有限制，这倒没什么问题，但大多数人早上都得按时起床。

So you will want to go to bed a little bit later and wake up a little bit later, which is fine if you're self employed or you don't have any restrictions on your time, but most of us need to be up at a certain time in the morning.

如果你的生物钟严重延迟，最终结果就是你会长期睡眠不足。

And if your circadian rhythm is delayed significantly, the net effect of that is that you're gonna end up sleep deprived.

再说，凌晨一点还在刷推特或者追Netflix剧集，本来就会让你推迟睡觉。

I mean, there's also the issue of being, you know, on Twitter or being engrossed in a in a movie on Netflix at 1AM that is going to make you delay sleep anyway.

所以这两种情况都存在。

So there are those

这是两个因素。

two effects.

它会让人兴奋。

It's arousing.

它让人兴奋，还会牢牢抓住你的注意力。

It's arousing, and it grips your attention.

是的。

Mhmm.

你怎么看这些人？

What do you make of these people?

我就属于那种睡觉前要看连环杀手电影的人。

Me being one of them that watch, you know, serial killer movies when we fall asleep.

我觉得，只有当这些东西让你睡不着的时候，才算是个问题。

Well, I think that that's only an issue if it's stopping you from falling asleep.

我经常跟我伴侣为此争执，你看过吗？

Did you see because I have this argument a lot with my partner.

她完全不明白，为什么我睡觉前非得看这么刺激的东西。

She she can't understand why I I need to watch this, like, really stimulating stuff when I fall asleep.

她喜欢安静，可我总觉得得听点什么才行。

She likes quiet, and I need to I I tell myself I need to, like, listen to something.

你觉得这种偏好差异大吗？

Do do you see, like, variance in in this kind of thing?

有没有更好的解决办法？

And is there a better approach?

这其实得因人而异，没有统一的睡眠方式。

This comes down to an individualized approach to sleep.

所以我从不轻易说哪种睡法才是完美的。

And that's why I'm always very reluctant to say this is the perfect night's sleep.

这些只是睡眠的一些基本原则。

These are the rules for sleep.

比如，有些人喝咖啡根本不会影响睡眠，临睡前喝杯双份浓缩咖啡，照样睡得着。

You know, for example, there are some people who, for whom caffeine doesn't really influence their sleep and can have a double espresso an hour before bed and still have no problems getting off to sleep.

但对我们大多数人来说，情况并非如此。

For most of us, that's not the case.

如果你能看一部特别刺激、特别吓人的片子，看完一关灯，翻个身就能睡着，那对你来说可能没什么问题。

If you are somebody who can watch something very stimulating, very scary, and then switch it off and roll over and go off to sleep, then I guess that's not a problem for you.

但对大多数人来说，晚上这么做恐怕不太合适。

For most people, that's probably not the best thing to be doing at night.

我觉得长期来看，一个大问题是，睡前在床上做这些事，会削弱床和睡眠之间的心理联系。

I think that long term, one of the issues is with all of these kinds of activities in bed at night before you go off to sleep is that they weaken the psychological associations between bed and sleep.

如果你总把床跟大脑活跃、精神投入的状态联系在一起，而你本身又容易失眠，那很可能就会慢慢演变成真正的失眠。

And so if you start associating bed being a place where you're mentally active, where you're engaged, then if you have an underlying predisposition to insomnia, for example, then that can sometimes set the stage for developing insomnia later on.

在你的临床实践中，你接触过的那些睡眠有问题的普通人，根本原因其实就像你刚才说的，是睡眠习惯不好。

The average person that you've treated worked with in your clinical practice that's struggling with sleep is at the heart of the issue just poor sleep hygiene like you've said there.

是的。

Yeah.

我身边有好多朋友都跟我说，他们睡不好。

Because I've got so many friends that say to me that they struggle with their sleep.

很多人这么困扰已经好多年了。

Many of them have struggled with it for years.

我不觉得会有这么多人天生基因就导致睡眠问题。

And I I doubt that there's some sort of genetic reason why this many people are struggling with sleep.

所以我猜，这更多是行为习惯上的原因。

So I imagine it's just some kind of behavioral reason.

我觉得，容易失眠的遗传倾向其实挺普遍的。

So I think that the genes that predispose to insomnia are pretty widespread.

但显然，在医学的几乎所有领域，都是基因和环境共同作用的结果。

But obviously, in pretty much all areas of medicine, is an interaction between genetics and environment.

确实，睡眠习惯差——虽然我很讨厌这个词，但它是目前最常用、也最容易被理解的说法——长期下来确实会引发一些行为模式，最终导致慢性失眠。

And certainly poor sleep hygiene, and that's a horrible term, I hate that term, but it's the term that is most widely used and understood, can certainly put in place certain aspects of behavior that then can give rise to chronic insomnia in the long term.

如果你已经患有严重的慢性失眠，单靠改善睡眠习惯几乎不可能解决问题。

So if you've got very bad chronic insomnia, then suddenly putting good sleep hygiene in place is unlikely to fix it.

但很可能，最初正是那些糟糕的睡眠习惯让你更容易患上失眠，或者至少增加了患病的风险。

But it may be that that poor sleep hygiene in the first instance gave rise or at least predisposed you to developing insomnia.

什么叫睡眠习惯差？

What is, poor sleep hygiene?

如果我想成为世界上最差的睡眠者，我该怎么做？

If I wanted to be the worst possible sleeper in the world, what would I have to do?

我觉得你得把办公区直接设在卧室里。

So I think you would probably have to, set up your home office in your bedroom.

明白了。

Okay.

你还得整天开着电视，就在卧室里。

You'd have to have, you know, your TV on in your bedroom all the time.

明白了。

Okay.

得让电子设备围在身边，晚上还喝很多咖啡，再喝点酒精饮料。

Have be surrounded by electronic devices, drink a lot of coffee late in the evening, alcohol, drinks a little bit of alcohol.

酒精在短期内确实有镇静作用。

So alcohol in the short term, of course, is is quite sedating.

它是中枢神经抑制剂，但会严重降低睡眠质量，原因很多：直接的化学影响、膀胱充盈、还有可能打鼾更厉害。

It's a central nervous system depressant, but it does dramatically worsen the quality of your sleep and for various reasons, the direct chemical effect, the fact that you've got a full bladder, fact that you're probably snoring a little bit more.

所以酒精真不是好东西，还有，不给自己留个放松的时间。

So alcohol is not a good thing, you know, not having a wind down period.

比如，一直玩股票到凌晨一点。

So, you know, gambling on the stock market until one a.

临睡前还盯着笔记本电脑，诸如此类的行为。

Switching your laptop and then trying to go to bed, those kinds of things.

这些就是典型的、极其糟糕的睡眠习惯。

So that's, you know, the quintessential very, very bad sleep hygiene.

那吃饭的时候呢？

What about when I eat?

吃饭这件事其实没那么关键，但睡前最好别吃大量高碳水食物，主要有两个原因。

So, you know, eating is perhaps less important, but avoiding a very large carbohydrate meal, carbohydrate rich meal before you go to bed for two reasons.

一是，这类食物容易导致血糖波动。

One is that we know that it can cause some fluctuations in terms of your blood sugar.

二是，如果你有胃酸倒流的问题，会加重症状。

And also, if you've got a bit of reflux, it can make that much worse.

明白了。

Okay.

和别人一起睡在床上呢？

What about sleeping in bed with somebody else?

这要看个人，毕竟每个人的情况不一样。

Well, I think that for some people, they find again, this goes back to no one rule for everybody.

如果你属于那种对环境特别敏感的睡眠类型，旁边人打鼾厉害，或者半夜起来两三次上厕所，确实会严重干扰你的睡眠。

You know, if you've got a sleep trait termed sleep reactivity, which is where your sleep is very liable to your environment, then obviously sleeping next to somebody who's snoring loudly or who gets up in the middle of the night two or three times to to to urinate can be can be very disruptive to your sleep.

如果你睡眠受环境影响很小，和别人同床反而可能让你觉得更舒服。

If you've got very little sleep reactivity, you may actually find it comfortable, more comfortable to sleep with somebody in the same bed as you.

我前几天在想，因为我现在搬的新家，卧室里没有窗帘或百叶窗。

I was I was thinking the other day because it where I've currently moved into, there's no blinds or curtains in my bedroom.

对。

Mhmm.

我在想，这说不定反而是个好事。

And I was wondering if that might be a good thing.

至少我的生物钟能保持稳定，每天都是太阳一出来就自然醒。

Because it at least means that in terms of my circadian rhythm, I'm waking up at the same time every day because I'm waking up when the sun comes up.

是的。

Yeah.

但太阳每天升起的时间都不一样啊。

But the sun comes up at different times at on different days, firstly.

如果你长期这样，夏天可能会严重睡眠不足。

So if you were doing that routinely, you might find yourself really rather sleep deprived in the summer months.

而且，最近有一些研究证据表明，睡觉时暴露在光线中对健康并不好。

And also, there is some emerging evidence that exposure to light at night in your sleep is not very good for you.

有一项非常新的研究发现，夜间接触光线会增加患糖尿病的风险。

So there was a very recent study that implied that light exposure at night increases your risk of diabetes.

所以，这确实对睡眠质量没什么好处。

So it certainly is not good for the quality of your sleep.

而且你很可能不会在天一亮就醒过来。

And the likelihood is that you won't wake up as soon as it's light.

你会在天亮后大约一个小时才醒，就在那段时间里。

You'll wake up an hour or so after it's got light during that hour or so.

这可能已经对你的睡眠质量造成了负面影响。

May have had a negative impact on the quality of your sleep.

所以，保持卧室黑暗是良好睡眠习惯的重要部分，就像保持卧室安静、温度不冷不热一样。

So having a dark bedroom is really part of good sleep hygiene, as it's having a quiet bedroom that is not too hot or too cold.

那如果戴眼罩呢？

What if you wear a sleep mask?

这样就能解决问题了吗？

Does that solve it?

是的，确实有效。

Yes, it does.

我是戴睡眠眼罩的。

I mean, I wear a sleep mask.

如果你卧室的遮光窗帘或百叶窗不够好，尤其是在夏天，戴睡眠眼罩会很有帮助。

I think it's, you know, particularly if you don't have good blackout curtains or blinds in your bedroom using a sleep mask, particularly in the in the summer months is probably very helpful indeed.

那是不是说，我们体内唯一的感光细胞都在眼睛后面？

Does that mean that the only light receptors we have are behind our eyes?

网上确实流传过一些说法，说身体其他地方也有感光细胞，但目前我们明确知道、对调节生物钟至关重要的，还是视网膜里的那些。

Well, I think that there was a there were some rumors on the Internet that there were light receptors elsewhere, but certainly the the only ones that we know to be of significance in terms of defining our circadian rhythm are the ones in our retinas.

我上中学的时候学过心理学，记得看过一本心理学书籍。

Because I I did psychology when I was in secondary school, and I remember reading one of the psychology books.

也许是我的心理学老师告诉我的，好像是洛尼女士，她说有些研究曾把光打在人的膝盖底下，没错。

Maybe my psychology teacher told me this, I think it was missus Lowney, that there were some studies where they shined a light, like, underneath someone's knees Yes.

人们在膝盖底下照光的时候，真的会醒过来。

And people would, like, wake up when they shine the lights there.

现在看来，这种说法已经被大大质疑了。

I I think that that's been that's been very much discounted now.

不过，唯一能感知光线的地方居然在眼睛后面，这确实有点奇怪。

It is a bit strange though that the only light receptor would be behind the eyes.

说不上来，就是觉得不太对劲。

It just feels like I don't know.

这设计也太不靠谱了吧。

It feels like poor design.

居然只有一个地方用来判断是白天还是黑夜。

That there's only one place where we figure out if it's night or day.

比如，你看那些失明的人，情况就是这样。

So so, you know, you see that, for example, in people who've lost their sight.

对。

Right.

有些完全失明的人，会失去对生物钟的调节，出现一种叫做非24小时睡眠节律障碍的情况，他们的生物钟周期会变成比如25小时。

So so in some individuals who have lost their sight completely, then they lose the regulation of their circadian rhythm and they develop circadian rhythm disorders, something called a non twenty four hour rhythm disorder whereby their circadian rhythm is on a, for example, a twenty five hour cycle.

所以每晚他们都会比前一天晚一小时睡觉，就这样一圈一圈地转，差不多每个月就能转完整个时钟。

And so every night they will go to bed one hour later than they did the previous night and will go right the way around the clock, you know, every month or so.

这其实很好地证明了，视网膜里的这些细胞对维持我们生物钟的稳定至关重要。

So, you know, that's a very good piece of evidence that actually it's those cells in the in the retina that are of crucial importance for maintaining the stability of our circadian rhythm.

我把它记下来了。

I I wrote that down.

最近有一项研究显示，百分之四十的全盲人士都有非24小时的生物节律，这让我更加意识到，关注自己的生物钟有多重要，它对全身的影响有多大。

I wrote down in one recent study, forty percent of totally blind individuals had a non twenty four hour circadian rhythm, which really kind of for me also highlights just how important it is to think about my circadian rhythm and how much impact it's having on my whole body.

你刚才提到的另一个部分，是我们生物钟里的生物因素，也就是所谓的昼夜类型。

The other part you mentioned was the biological element to our circadian rhythms which people refer to as chronotypes.

对。

Yes.

这种昼夜类型，据我理解，就是说我们每个人在基因上都有一点倾向，会在特定时间更容易入睡。

And this idea of chronotypes which is essentially from my understanding that genetically we all have a slight sort of disposition to sleep in at certain times

是的。

Yes.

而且在特定时间醒来。

And to wake up at certain times.

对。

Yeah.

所以这些还有专门的叫法，对吧？

So there's these names, right?

比如夜猫子、云雀之类的。

There's like the owl, the the lark or whatever else.

我觉得我是夜猫子，不过也可能只是习惯不好。

I think I'm an owl, that also could just be bad habits.

没错。

Yeah.

确实，这种遗传倾向是存在的。

So so, you know, certainly, there's that sort of genetic predisposition.

还有环境因素，而且随着我们人生不同阶段的推移，生物钟也会发生一些变化。

There's also these environmental factors, but there's also age in the archaicadian rhythm changes a little bit as we go through different stages of life.

所以，青少年变得更偏向夜间型，这其实非常普遍。

So, you know, it's not at all uncommon for teenagers to become more evening chronotypes.

等我们年纪大了，又会慢慢回到早起的节奏。

And then as we get older, we tend to shift back to the morning.

这其实也是我们衰老过程中生物学的一部分。

So that's part and parcel of our aging biology as well.

所以我觉得，遗传确实很重要，但其他因素也同样关键。

So so I think that, you know, genetics is really important, but so but so are other factors as well.

双胞胎研究显示，我们的作息类型中，高达百分之五十是由基因决定的。

Studies in twins, suggest that up to 50% of our chronotype is under genetic control.

对。

Mhmm.

那这是否意味着我们和家人很可能有相似的作息类型？

So does that suggest that we are likely to have a similar chronotype to our family?

我们确实很可能有相似的作息类型，但环境显然不会和父母那一辈完全一样。

We are likely to, but obviously, environment is not going to be exactly the same as our parents.

我们的生活习惯，不可能跟父母或者兄弟姐妹一模一样。

You know, what we do, our behaviors are not going to be identical to our parents or our siblings.

所以，我们经常看到，比如晚睡型的作息确实会在家族里遗传。

So, yes, we've more frequently see that, for example, people have a evening chronotype that runs in families.

但这并不意味着，我们的命运就完全被基因决定了。

But that doesn't mean that look, we're we're we're more than just the destiny of the genes that we hold.

基因当然非常重要，但其他因素也同样关键。

Obviously, our genes are really important, but so are other factors as well.

如果有人来找你，说他连续好几天都睡不着，一上床就毫无睡意。

If someone came to you and they said, I'm struggling with my sleep, you know, multiple nights in a row, haven't been able to sleep.

躺下之后什么反应都没有。

I'm getting in bed and nothing's happening.

醒来后就躺在那儿一直想着睡觉的事，感觉糟糕透了。

And then I'm waking up and I'm just sat there thinking about, you know, sleeping and, I feel horrific.

你会从哪里开始？

Where would you start?

我觉得第一步是弄清楚到底是什么导致了他们的睡眠问题。

So I would start, I think, by trying to understand what it is that is causing their sleep issues.

因为我接触的很多患者，一来就说自己有失眠，但其实未必真的是失眠。

Because a lot of the individuals that I see who have been referred in with that sort of picture assume that they've got insomnia, and they may not always have insomnia.

关键在于，我们对自己睡眠状况的感知往往非常不准。

So I think a key issue is that we are really, really poor witnesses to our own sleep.

我的意思是，我们主观感受到的睡眠和实际的睡眠情况常常差别很大。

And what I mean by that is that we often our experience of sleep is very different to the reality of sleep.

当我们把患者带到睡眠实验室做检查时，这种情况一点都不罕见。

When we bring in people into the sleep laboratory, it's not at all unusual.

每次给患者做睡眠监测时，我几乎都会问一个问题：你觉得你昨晚睡了多久？

And I will almost always ask this question when I'm going through a sleep study with one of my patients is how much sleep do you think you got over the course of that night?

很多人会告诉我，我觉得自己只睡了两三个小时。

And it's not at all unusual for people to say to me, well, I think I got two or three hours sleep.

有时候，他们甚至说：‘我一整晚都没睡着。’

Occasionally, even they say, well, I didn't sleep at all.

但当你查看他们的脑电波，看他们睡眠最客观的指标时，会发现他们其实睡了七个半小时，甚至八个小时。

And then you look at their brain waves, you look at the best objective marker that you've got of their sleep, and you see that they've slept seven and a half, eight hours.

所以，人们主观的感受确实很重要，因为从我的角度看，我最关心的是如何改善他们对睡眠的体验，以及他们真正抱怨的问题。

So obviously, what people are experiencing is really important because ultimately, from my perspective, I want to improve people's experience of their sleep and what it is that they're they're they're complaining of.

但也要明白，他们告诉你的未必就是客观事实。

But it's important to understand that what they're telling you may not necessarily be the objective truth.

这一点在治疗失眠时特别关键，因为我经常遇到一些患者，他们描述的症状非常明确地指向失眠，但当你客观地分析他们的睡眠数据时，会发现虽然他们说自己完全没睡，实际上却睡了七个小时，只是这七小时被各种问题严重打断了，比如周期性肢体运动障碍——那种和不宁腿综合征相关的腿部抽动，或者睡眠呼吸暂停。

Now that's really important when it comes to insomnia because it's not unusual for me to see individuals who you know, they give you a story of very clear insomnia, but, actually, when you look at their sleep objectively, you find that although they say they haven't slept at all, they've slept seven hours, but that seven hours has been completely disrupted by conditions like periodic limb movement disorder, which is these leg kicks associated with restless leg syndrome, or sleep apnea, for example.

当然，有时候从患者描述中就能明显看出，他们确实就是单纯的失眠。

Now, sometimes it's very evident from what people tell you that actually that's not the case, that they've just got very clear insomnia.

所以，这正是判断的起点：你能否通过临床评估，足够有信心地确定问题所在，而无需安排睡眠监测。

So that's really the starting point to try and decide whether or not you feel confident enough in your clinical evaluation of them that that you know what the issue is without doing a sleep study.

如果你觉得他们确实需要做睡眠监测，那就到了该安排的时候了。

And if you think that they do need a sleep study, then that's the point at which we we are we arrange for that.

还要试着弄清楚可能影响他们睡眠的一些因素。

It's also trying to understand some of the factors that might be driving their sleep difficulties.

比如，他们的睡眠问题是不是由某个生活事件引发的？

So for example, was their sleep were their sleep difficulties triggered by a life event?

在出现失眠之前，他们是不是本来就对睡眠特别敏感？

Did they have sleep reactivity before this insomnia started?

他们是那种无论何时何地都能睡着的人，还是说，只要第二天有考试、面试或者演讲，前一晚就睡不着？因为这种反应往往是日后发展成失眠的强烈信号。

So were they one of those individuals who could sleep anywhere, anytime, whenever they wanted, whenever they wanted to put their head down, or whether they kind of individual who the night before an exam, before a job interview, before a presentation would lose sleep, because that often is a very strong marker for developing insomnia later on in life.

同时，也要了解他们的整体健康状况如何受睡眠影响，以及他们的健康状况又如何反过来影响睡眠。

And then it's also about trying to understand how the rest of their health is impacted by their sleep, but also how the rest of their health impact on sleep.

我经常遇到一些人，本来是因为其他原因开始服药，结果却引发了睡眠问题。

So it's not at all unusual for me to see individuals who have been started on medications for other reasons that have generated sleep issues, for example.

你提到过这种对睡眠的过度关注。

You talked about this sort of obsession with sleep.

我想知道，对于你刚才说的那位患者，你会建议他戴睡眠追踪器吗？

And I was wondering in the case of the patient you've just described, would you encourage them to wear a sleep tracker?

首先，我得说，我对睡眠追踪器本身并没有意识形态上的抵触。

So first of all, I have to say that I'm not ideologically opposed to sleep trackers in general.

我觉得它们在研究领域真的非常有用。

I think that they are really, really good, for example, in research.

在研究中简直太棒了。

You know, fantastic for research.

它们让我们能够追踪大量人群的睡眠情况，从而分析睡眠与我们关注的其他因素之间的关联。

It allows us to track sleep in very, very large numbers of individuals and try and work out how that correlates with whatever we're interested in.

睡眠追踪器的一个主要问题是，经常使用它们的人，往往本来就已经对睡眠感到担忧。

One of the major issues with sleep trackers is that the people who often use sleep trackers are individuals who already are concerned about their sleep.

如果你知道自己睡得不多，早上醒来还觉得累，那你大概早就意识到自己睡眠不足了。

So if you know that you're sleeping relatively little and you wake up feeling tired, then you probably know you're not sleeping enough.

你其实并不需要睡眠追踪器来告诉你这一点。

You don't necessarily need a sleep tracker to tell you that.

如果你是那种患有失眠、躺在床上很久却怎么也睡不够的人，那么睡眠追踪器只会让你对睡眠更加焦虑。

If you're one of these individuals who has insomnia, who is spending plenty of time in bed but simply cannot get the amount of sleep that they need, then what a sleep tracker will do is it will increase your concern, your anxiety around your sleep.

这和用计步器的情况完全不同。

It's a very different picture for from, for example, using a step tracker.

如果你坐在沙发上，看一眼计步器，发现只走了五千步，那很容易站起来去散个步，再走五千步。

If you're sitting on the sofa and you look at your step tracker and you realize you've only done whatever it is, 5,000 steps, it's very easy to get up and go for a walk and do another 5,000 steps.

如果你的睡眠追踪器告诉你昨晚睡得很差，而你自己也知道睡得不好，本来就担心睡眠质量，那你就没法根据这个信息立刻多睡一会儿。

If your sleep tracker is telling you you slept really badly and you know you slept really badly and you're already worried about how badly you sleep, there's nothing that you can do on the basis of the information that your sleep tracker is giving you to suddenly go and get a little bit more sleep.

而且，睡眠追踪器确实挺擅长记录你躺在床上的时间。

And it's complicated by the fact that, you know, sleep trackers are pretty good at telling you how much time you spent in bed.

它们也能比较准确地判断你多久入睡。

They're reasonably good at telling you how quickly you dropped off to sleep.

但这些设备在判断夜间醒来次数、睡眠阶段这些细节时，准确率就明显下降了。

The reliability, the accuracy of these devices, most of these devices drops off significantly when it comes to, for example, defining nighttime awakenings, defining stages of sleep, those kinds of things.

这就带来另一个问题：有时候睡眠追踪器提供的数据根本不对，反而让你更焦虑。

So then you have that additional issue in the mix, which is that sometimes that your sleep tracker may be giving you information that is not factually correct, and that may increase your anxiety further.

所以我特别建议有睡眠问题的人，别再熬夜硬撑了，干脆把睡眠追踪器收起来，去找医生聊聊，或者找懂睡眠的人咨询，别总依赖这种追踪技术。

So I'm really very, very keen for people who have issues with their sleep rather than just burning the candle at both ends to put away their sleep tracker and actually go and have a chat with their GP or somebody who knows a little bit about sleep rather than relying on this sleep tracking technology.

你觉得睡眠追踪器对睡眠文化产生了负面影响还是正面影响？

Do you think sleep trackers have had a negative or positive impact on sleep culture?

我觉得对于那些只要多在床上待一会儿就能改善睡眠的人来说，这确实有帮助。

I think that for those individuals who can fix their sleep in a very straightforward way by spending more time in bed.

就是我之前提到的那类人，二十年前他们总说：我每天只睡五个小时，因为我忙着做这个、那个，但也能撑得住。

So the kinds of people that I talked about that twenty years ago would be saying, well, you know, I only sleep five hours and, you know, because I'm busy doing X, Y, and Z, and I can get away with it.

我觉得睡眠追踪器让他们意识到自己睡得不够，于是更愿意多在床上待一会儿，因为数据清清楚楚摆在那儿。

I think it's probably encouraged them to spend a bit more time in bed because they know they have a very clear, very clear bit of information that's telling them that they're not sleeping enough.

但对我接触的那些本来就担心睡眠、已经有睡眠问题的人来说，它的影响完全是负面的。

But for the people that I see, the people who are already concerned about their sleep, and who have difficulties with their sleep, I think it's been a very negative impact.

而且我对像我这样的人——在播客里、在报纸上告诉别人‘你要是睡不够，会早死’——有点保留意见。

And I have some reservations about, well, people like myself, sitting on these kinds of podcasts or writing in newspapers telling you, well, you know, if you don't get enough sleep, you're gonna die early.

说什么你睡不够就会引发各种健康问题。

You're gonna have all these negative health consequences.

因为对那些本来就极度焦虑睡眠的人来说，这种说法反而会

Because for a subgroup of individuals who are already very concerned about their sleep, that actually can

因为啊

cause And

我见过一些人，他们读了很多关于睡眠重要性的书，结果反而陷入失眠，甚至出现严重的抑郁和焦虑。

I have seen individuals who, for example, have read books on sleep and how important it is on sleep, who have ended up going into a spiral of insomnia and very catastrophic depression and anxiety as a result.

所以呢，这一点非常关键，我们必须清楚，这事儿是一把双刃剑。

So so it's very, you know, it's very important to be clear that the all of this is a double edged sword.

睡眠追踪器确实挺有意思的。

It's interesting with with sleep trackers.

我觉得我得说明一下，我既是Whoop的投资人，也接受Whoop的赞助。

I can see I think it's worth me saying that I am both an investor in Whoop, and I'm also sponsored by Whoop.

明白。

Okay.

不过你说的这些，我也完全认同。

But I also agree with the things you've said.

我确实看到，睡眠追踪器对有些人帮助很大，能改善生活，但对另一些人却反而加重了焦虑，效果适得其反。

So I've seen this sort of variance in how a sleep tracker can improve some people's lives and it can make other people more anxious in a way that's not helpful.

对我来说，我的亲身经历是，我曾经就是你前面说的那种人，觉得睡不睡觉都无所谓。

So for me, my sort of testimony on it is I was one of those people you described earlier that thought sleep was take it or leave it.

但当我开始用睡眠追踪器时，就像我第一次做脑部扫描，看到自己的大脑一样，我才意识到原来它一直都在，而且我能影响它，我平时做的那些事其实都有很大影响。

And when I started seeing a sleep track, it's kind of like that when I saw my brain for the first time, did a brain scan and I didn't even kind of like realize it was there and that I could influence it and that things I was doing Mhmm.

我以前根本没怎么在意这些习惯，没想到它们居然有这么大作用。

Without really thinking much were having this big impact.

对我而言，这让我终于把睡眠时间和自己的行为联系了起来。

And for me, what it did is it allowed me to finally make this link between how much sleep I've had and then how I behave.

以前我觉得自己的情绪和行为完全是随机的。

Now I thought my behavior was random before.

但后来我发现，一旦睡眠评分低，我就更容易情绪化。

But seeing that when when my sleep scores were down, I was way more emotional.

也更容易吃垃圾食品。

I was way more likely to eat crap.

还有一件特别有意思的事是，只要我喝了一两杯甚至三杯酒，第二天的睡眠就彻底完蛋了。

And the other thing that I saw which was really interesting was that when I had a glass of wine or two glasses of wine or three glasses of wine that it just like destroyed my sleep.

我以前从来不知道这一点。

And I never knew that before.

其实我本来也在找理由戒酒。

And I was in search of reasons to quit alcohol anyway.

看到这个结果后，我就彻底戒了酒。

And when I saw that, I quit alcohol forever.

从那以后，我一口酒都没再碰过。

So I've not drunk since.

当然，生活中总有些时候事情突发，我知道自己肯定睡不好，那时候我就干脆不管睡眠追踪器了。

So and then for me, I have to also say there are moments in my life where life happens and I know I'm not gonna sleep and I don't pay attention to my sleep tracker.

但也有不少时候我能掌控节奏，这时候我就会认真看我的睡眠数据。

But there are other moments where I have a bit more control and that's when I kinda tune into my sleep tracker.

还有很多父母给我留言，说：我家里有个一岁、两岁、三岁的孩子，反正我也不可能睡好，戴睡眠追踪器也没用。

I've also had parents message me a lot and say, listen, I've got a one year old, a two year old, a three year old, whatever.

反正我根本睡不了觉，何必在意这些数据呢。

There's no point me wearing a sleep tracker because listen, I'm not gonna get any sleep.

我也完全同意他们的看法，这种情况下确实没什么意义。

And I also completely agree with them that there's really no point in that situation.

我觉得，只有当你能做点什么的时候，才有意义。

I think there's a point when there's something you can do about it.

是的。

Yeah.

这恰恰是最关键的。

And that's that's that's absolutely key.

对。

Yeah.

所以，做这类事情的意义在于，如果你能自己明确地采取行动来解决问题，那信息才有价值；如果有了数据却没法行动，那就没必要了。

So so the the the the point of doing anything like that is if there are very clear things that you can do on your own to close that loop, there's no point having information without being able to act upon it.

没错。

Yeah.

如果你像你自己这样，能很清楚地把白天的行为和睡眠质量、第二天的状态联系起来，那当然再好不过。

And I guess if you are one of those individuals like yourself who very clearly can correlate certain things that they're doing in their daytime lives with their sleep and and and how they feel subsequently, then then great.

你知道，我有点偏向于我接触的这些人，他们本来就已经在为睡眠问题困扰了。

You know, I guess I have a little bit of bias in that the people that I see are already struggling with their sleep already.

所以这么说来，我们完全达成一致了。

And so it goes back I I guess we're completely in agreement.

是的。

Yeah.

对。

Yeah.

没错。

We are.

是的。

Yeah.

这其实挺有意思的，因为这个想法是我慢慢形成的——我一向觉得，你难道不希望知道吗？

And it's so interesting because I that's been a developing idea because, obviously, my bias is always like, wouldn't you rather know?

因为按理说，但通过做这个播客，我看了很多评论，也听了很多父母讲述他们睡眠不好时的挣扎，有时候知道得太多反而让他们更焦虑了。

Because that's, you know but then from doing this podcast, I've I've seen the comments and I've seen the struggle in from speaking to parents that struggling with their sleep and it's kinda sometimes just makes them feel worse about it.

我觉得这个问题上，细节很重要。

I think nuance is necessary on this issue.

你刚才听到的，是上一集里被反复播放的一个片段。

What you just listened to was a most replayed moment from a previous episode.

如果你想听完整的那一集，我在下面提供了链接。

If you wanna listen to that full episode, I've linked it down below.

详情请看简介。

Check the description.

谢谢。

Thank you.