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对抗抑郁症,也许你只需调整睡眠时间

更新时间:2017-3-14 10:29:42 来源:纽约时报中文网 作者:佚名

Yes, Your Sleep Schedule is Making You Sick
对抗抑郁症,也许你只需调整睡眠时间

Jet lag makes everyone miserable. But it makes some people mentally ill.

飞行时差会让所有人苦不堪言。但它还会让一部分人患上精神疾病。

There’s a psychiatric hospital not far from Heathrow Airport that is known for treating bipolar and schizophrenic travelers, some of whom are occasionally found wandering aimlessly through the terminals. A study from the 1980s of 186 of those patients found that those who’d traveled from the west had a higher incidence of mania, while those who’d traveled from the east had a higher incidence of depression.

一家离希思罗机场(Heathrow Airport)不太远的精神病医院,以治疗患上双相情感障碍和精神分裂症的旅行者闻名——他们中的一些人被发现在航站楼内毫无目的地闲逛。1980年代的一项以186名此类患者为对象的研究表明,乘飞机从西边出发的旅行者患上躁狂症的几率较高,从东边出发的人则有更高几率患上抑郁症。

I saw the same thing in one of my patients who suffered from manic depression. When he got depressed after a vacation to Europe, we assumed he was just disappointed about returning to work. But then he had a fun trip out West and returned home in what’s called a hypomanic state: He was expansive, a fount of creative ideas.

我在自己的一位受躁狂抑郁症折磨的病人身上看到了同样的情况。他去欧洲度了一次假之后变得很抑郁,我们当时还以为他只是对重返工作岗位感到沮丧。但他随后踏上了一趟有趣的西游之旅,回来时处于所谓的轻躁狂状态:他的思维变得很开阔,创造性想法源源不绝。

It was clear that his changes in mood weren’t caused by the vacation blues, but by something else. The problem turned out to be a disruption in his circadian rhythm. He didn’t need drugs; he needed the right doses of sleep and sunlight at the right time.

显然,导致其情绪发生变化的并不是假日忧伤,而是别的什么因素。原来,他的生物钟被打乱才是问题所在。他无需用药;他需要适度的睡眠,还有就是在恰当的时间晒晒太阳。

It turns out that that prescription could treat much of what ails us.

事实证明,这一处方有助于我们摆脱很多困扰。

Clinicians have long known that there is a strong link between sleep, sunlight and mood. Problems sleeping are often a warning sign or a cause of impending depression, and can make people with bipolar disorder manic. Some 15 years ago, Dr. Francesco Benedetti, a psychiatrist in Milan, and colleagues noticed that hospitalized bipolar patients who were assigned to rooms with views of the east were discharged earlier than those with rooms facing the west — presumably because the early morning light had an antidepressant effect.

临床医生早就知道,睡眠、阳光和心情之间有着很强的关联度。睡眠出问题常常是抑郁症即将发作的一个警告信号或原因,会让患有躁郁症的人处于躁狂状态。大约15年前,米兰的精神科医生弗朗西斯科·贝内德蒂(Francesco Benedetti)博士及其同事注意到,在入院治疗的躁郁症患者中,被分派住进东向房间的那些人,会比住进西向房间的人早出院——很可能是因为清晨的阳光有抗抑郁作用。

The notion that we can manipulate sleep to treat mental illness has also been around for many years. Back in the late 1960s, a German psychiatrist heard about a woman in Tübingen who was hospitalized for depression and claimed that she normally kept her symptoms in check by taking all-night bike rides. He subsequently demonstrated in a group of depressed patients that a night of complete sleep deprivation produced an immediate, significant improvement in mood in about 60 percent of the group.

可以通过调节睡眠治疗精神疾病的观点早已有之。1960年代末,德国的一名精神科医生听说,蒂宾根市一个因患抑郁症入院治疗的女人声称,她通常以整夜骑自行车的方式遏制症状。这名医生随后在一群抑郁症患者身上证实,一整晚的睡眠剥夺会让这群患者中的60%立即出现显著的情绪改善。

Of course, total sleep deprivation is impractical, to say nothing of the fact that you will crash back into depression as soon as you catch back up on sleep. It also just seems counterintuitive that taking sleep away can help someone feel better. After all, most of us think of sleep as comforting and desirable. So how does this work?

当然了,完全剥夺睡眠是不切实际的,更别说你一旦补充睡眠就会重新崩溃陷入抑郁了。剥夺某人的睡眠有助于让其更好受,听上去也有悖直觉。毕竟,我们中的大多数人都认为睡觉是一件舒服、惬意的事情。那么,这种办法是如何起作用的?

One theory is that depressed people have something wrong with their circadian rhythm. Their bodies tend to release melatonin — a hormone that regulates sleep — earlier in the evening than non-depressed people, and they tend to wake up earlier in the morning.

一个理论是,抑郁症患者的生物钟出了某种问题。比起没患上抑郁症的人,他们的身体往往会在傍晚提早释放褪黑素——一种调节睡眠的荷尔蒙——使得他们在清晨提早醒来。

But even if you don’t have depression, your circadian rhythm may cause trouble. Most people’s natural cycle is somewhat longer than the 24-hour solar day, which means that, left to our own devices, we would get quickly get out of sync with the external world. That is exactly what happens when humans are isolated from external cues — say, in a lab setting or stuck in a mine.

但即便你并未患上抑郁症,你的生物钟也可能造成麻烦。大部分人身体的天然周期比24小时的太阳日要长,这意味着如果让身体自行其是,我们很快就会和外部世界不同步。当人类无法从外界获得指引时,比如置身于实验室环境中或被困在矿井里,情况恰恰如此。

The reason we don’t all walk around in a state of perpetual jet lag, waking and sleeping at random, is that our circadian rhythm evolved to be tied to the solar day. In other words, our internal clock is easily influenced and kept in check by the daylight cycle.

我们并不会长期处于倒不过时差的状态、随便醒来和入睡,是因为我们的生物钟经过进化,与太阳日挂上了钩。换句话说,我们的生物钟很容易受日光周期影响和控制。

I started thinking about this a few years ago, on a red-eye flight from New York to Rome, when I was rudely awakened somewhere over the Atlantic by the familiar airline ritual of opening the shades to blinding early-morning sunlight. What, I wondered, was this light doing to my brain?

我是在多年前乘坐一趟红眼航班从纽约飞往罗马时开始思考这个问题的。当时,我在大西洋上空的某个地方,被航班上为人熟知的惯例——打开百叶窗让清晨刺眼的阳光照进来——猛然惊醒。我禁不住琢磨,这些光线对我的大脑有什么影响?

When you quickly cross several time zones, your circadian rhythm remains stuck in the city you left behind. Arriving in Rome with your New York City brain is what produces the unpleasant symptoms of jet lag: fatigue, malaise, poor concentration and mood changes.

当你快速跨越若干时区时,你的生物钟还死守着被你抛在身后的城市。带着属于纽约的大脑抵达罗马,便会遭逢种种令人不快的倒不过来时差的症状:疲劳、不适、注意力不集中,以及情绪变化。

When you leave New York at 6 p.m., the Italians are probably in bed asleep. But you won’t feel ready for sleep until around 11. To make the right adjustment, you need to shift your internal clock earlier by six hours.

当你在傍晚6点离开纽约时,意大利人可能已经入睡。但你直到11点左右才会有想要睡觉的感觉。为了做出适当的调整,你需要把自己的生物钟调快六个小时。

Unfortunately, exposure to light in the middle of the night will do the opposite. Instead of shifting you earlier to Italian time, it makes you feel it’s even later — that the night is over and it’s already morning.

不幸的是,在深夜暴露在光下会起到相反的作用。不仅不能让你把生物钟往前调到意大利时间,反而会让你觉得时差更大——觉得那个夜晚过去,已经是早上了。

If you’re ever in that situation, close the shades and put on dark sunglasses. Keep the glasses on until lunchtime in Rome — or 7 a.m. back home. Then go out into the sun, have an espresso and enjoy the splendor of the ancient city. This will shift your clock closer to Roman time.

如果你碰到这种情况,就拉上窗帘,带上黑色的太阳镜。直到罗马的午餐时间再摘掉——也就是家乡早上7点的时间。然后你走进阳光里,喝一杯浓缩咖啡,感受这座古城的辉煌壮丽。这会让你的生物钟更贴近罗马时间。

The clock in your brain doesn’t just take cues from light, but from the hormone melatonin as well. Every night, about two to three hours before you conk out, your brain starts to secrete melatonin in response to darkness. Taking a melatonin supplement in the evening will advance your internal clock and make it possible to fall asleep earlier; taking it in the morning will do the opposite. (You might assume this would make you even more tired during the day but it won’t; you could think of it as tricking your brain into believing you slept longer.)

你脑中的时钟不仅听从光线的提示,也接受褪黑素这种荷尔蒙的指示。每天晚上在你睡着前两三个小时,你的大脑便对黑暗做出反应,开始分泌褪黑素。在晚上服用褪黑素补充剂可以将你的生物钟往前调,让你有可能更早进入睡眠;早上服用则会晚睡。(你可能觉得这会让你在白天感觉更疲劳,但它不会;你可以把它理解成欺骗你的大脑,让它觉得你睡了更长时间。)

So now you know the fix for jet lag: Travel east and you’ll need morning light and evening melatonin; go west and you’ll need evening light and morning melatonin.

所以现在你知道解决时差综合征的办法了:往东去的话,就需要早上接受光照、夜晚服用褪黑素补剂;往西去则需要夜晚亮灯,早上服用褪黑素。

The same principle tells us what to do for night owls, the 5 percent to 10 percent of adults who don’t start releasing melatonin until late. If they try to sleep at a normal hour, like 11 or midnight, they will have “insomnia,” because they don’t feel sleepy yet — their natural circadian rhythm is delayed.

基于同样的原则,我们也知道了如何对付夜猫子——直到很晚才会释放褪黑素的5%至10%的成人。如果他们试图按照正常时间作息,比如在晚上11点或凌晨入睡,就会出现“失眠症”,因为他们那时候还不觉得困——他们的自然生物钟是推迟的。

Many will take sleeping pills, which cannot fix the underlying cause. It would be more effective to take a small dose of melatonin a few hours before the desired bedtime. They could also try a treatment called chronotherapy, which alters the circadian rhythm. This involves exposure to bright lights at progressively earlier times in the morning, which should make it easier to fall asleep earlier. Finally they should avoid too much light in the evening, especially the blue light that smartphones and computers emit. (Or they can wear glasses that block blue light.)

许多人会服用安眠药,这不能解决根本问题。在想要实现的睡眠时间几小时之前服用小剂量褪黑素,才是更有效的办法。他们也可以尝试一种被称为时间疗法的治疗方法,它可以改变人的生理节奏。其方式包括在早上接受光照,而且逐渐把这个时间往前提,这会让人更容易早睡。最后,他们应该避免在晚上接受太多光照,尤其是智能手机和电脑发出的蓝光。(或者佩戴可以屏蔽蓝光的眼镜。)

Most of us have an indirect sense of our internal clock time just by knowing when we prefer to go to bed. But you can get a more objective measure of your circadian rhythm — or chronotype — and advice on what to do about it by taking this simple quiz.

因为知道自己宁愿什么时候睡觉,所以我们大多数人自己对内在的生物钟有一种间接的感觉。但通过做这个简单的测试,你可以对自己的生物钟——或“时型”——进行更客观的测量,并获得建议。

Those with more serious problems than jet lag and late nights may need to make more serious changes.

如果比时差综合征和晚睡更严重的问题,则可能需要做出更重大的改变。

Researchers have developed a limited form of sleep deprivation that is euphemistically called wake therapy. It has been shown to have sustained antidepressant benefit in patients with bipolar disorder and major depression. The idea is to get up for the day halfway through the usual sleep period, which shifts the circadian clock to an earlier time. It’s thought that this works by realigning the sleep cycle with other circadian rhythms, like changes in levels of body temperature and the stress hormone cortisol, that are also out of sync with each other in depression.

研究人员开发了一种有限的睡眠剥夺方式,它被委婉地称为叫醒疗法。这种疗法在躁郁症和重度抑郁症患者身上已经表现出具有持续抗抑郁的效果。它是在通常的睡眠时段中途起床,这能将生物钟调整到较早的时间。这种方法被认为可以调整睡眠周期,使之与体温和应激激素皮质醇变化等其他生理节律同步——出现抑郁症时,这些生理节律也彼此不同步。

Studies show that it is possible to make wake therapy even more powerful by incorporating two additional interventions: early morning light therapy and what’s called sleep phase advance, in which the patient goes to bed about five to six hours earlier than usual and sleeps for about seven hours. This combination of treatments is called triple chronotherapy, and the typical course involves one night of complete sleep deprivation followed by three nights of phase-advanced sleep and early morning light.

研究表明,通过结合另外两种干预措施,可以使叫醒疗法更为有效:清晨阳光疗法和所谓的睡眠周期提前疗法,在后面这种疗法中,患者比平常早睡5至6个小时,睡眠约7个小时。这三种疗法的组合被称为三倍时间疗法,典型的治疗过程包括一整晚的完全睡眠剥夺,然后是三个晚上的睡眠周期提前疗法和清晨阳光疗法。

In one study of 60 hospitalized patients with bipolar depression who were taking antidepressants or lithium, 70 percent of those who did not have a history of drug resistance improved rapidly with sleep deprivation and early morning light, and 57 percent remained well after nine months. Encouragingly, 44 percent of patients who had failed to respond to at least one trial of anti-depressants also improved.

在一项对60名正在服用抗抑郁药或锂的住院躁郁症患者的研究中,70%没有耐药史的患者通过睡眠剥夺和清晨阳光疗法快速取得改善,57%的患者在9个月后依然状态良好。令人鼓舞的是,至少对一种抗抑郁药物没有反应的患者中,44%的人也有所改善。

In another study, investigators combined chronotherapy with psychotropic medication and found that depressed patients got better within 48 hours — much faster than antidepressants, which typically take four to six weeks to work. A second study of 75 depressed patients who were taking an antidepressant randomly assigned half to also receive chronotherapy and the other half to daily physical exercise. It found that 62 percent of patients remained well at the end of 29 weeks in the chronotherapy group compared with only 38 percent assigned to exercise.

在另一项研究中,研究者联合使用时间疗法与精神药物,发现抑郁症患者在48小时内得到改善——比抗抑郁药要快得多,后者通常需要4至6周才能起效。在另一项研究中,75名正在服用抗抑郁药的抑郁症患者被随机分成两半,其中一半也接受时间疗法,另一半进行日常体育锻炼。结果发现,29周后,时间疗法组62%的患者依然状态良好,而分配到运动组的患者中,只有38%的人状态良好。

With the possible exception of ketamine, a drug under investigation for treating depression, this therapy is the most rapid antidepressant treatment that we have. About 60 percent of depressed patients feel markedly better within hours. And — with the exception of some fatigue — there are no side effects.

可能除了氯胺酮(一种正在研究的用于治疗抑郁症的药物)之外,这种疗法是我们目前拥有的能最快缓解抑郁症的疗法。约60%的抑郁症患者在数小时内明显感觉改善。除了有点疲劳,没有其他副作用。

No doubt you are wondering why more depressed patients don’t receive chronotherapy. First, you cannot patent sleep deprivation or light, so there is little financial incentive to invest in this treatment or research.

你肯定想知道为什么没有更多的抑郁症患者接受时间疗法。首先,睡眠剥夺或阳光无法成为专利,所以在这种疗法或研究上进行投资几乎没有经济激励。

That seems shortsighted to me. Research into altering the circadian clock to produce powerful antidepressant benefits could lead to the development of drugs that might mimic the effect of sleep deprivation, but without its obvious drawbacks.

但我觉得那是很没远见的想法。对改变生物钟以产生强大抗抑郁效果的研究可能促成开发出能模仿睡眠剥夺效果的药物,而且没有睡眠剥夺的明显缺点。

Beyond that, doctors don’t learn much about chronobiology in medical school or residency. There are only a handful of doctors and medical centers that administer these treatments. But there is nothing to stop clinicians from incorporating chronotherapy into their practices right now. I already use light and melatonin to help my patients with jet lag and to readjust their circadian rhythm, but it won’t be long before I try triple chronotherapy for my depressed patients who don’t get better with antidepressants.

另一个原因是,医生在医学院或住院实习期间对生物钟没有很多了解。只有少量医生和医疗中心进行这种治疗。但没什么能阻止临床医生将时间疗法纳入治疗之中。我已经使用阳光和褪黑素来帮助病人应对时差,调整生物钟,但不久之后,我会尝试用三倍时间疗法治疗我的那些无法用抗抑郁药物获得改善的患者。

Whether chronotherapy will prove as widely effective as conventional antidepressants for serious depression is still unknown. But there is no question that we can relieve everyday problems like jet lag and insomnia simply by better aligning our circadian rhythms with the world around us. What could be more natural than that?

时间疗法是否会被证明和常规抗抑郁药一样对重度抑郁症有广泛疗效仍未可知。但毫无疑问,我们可以简单地通过让我们的生理节律与周围的世界更加协调来缓解时差和失眠等日常问题。还有什么比这更自然呢?

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