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  • The early part of my career as a clinical psychologist

    在我最初的職涯中,我是一名臨床的心理學家

  • was spent in addiction research and treatment,

    研究及治療「成癮」這件事

  • and now I treat sleep.

    而現在,我治療「睡眠」

  • So when I reflect on my path, I feel as if I can legitimately say

    所以,當我回想到過去的時光,我就覺得我可以很合理的稱這段時間為:

  • that I went from helping people become conscious to helping people become unconscious.

    我從幫助人們變得清醒到幫助人們變得無意識

  • (Laughter)

    (笑聲)

  • I love sleep treatment.

    我喜歡睡眠治療這份工作

  • I think that sleep is so fascinating and it's exquisitely complex.

    睡眠這件事是如此的令人著迷且複雜

  • For people navigating that sleep treatment world, though,

    即使對於那些航行於睡眠治療世界的人而言

  • trying to figure out what to do can be very daunting.

    「該如何去做」這件事,令他們感到畏懼

  • I was even surprised to find out

    我甚至很驚訝

  • that some of the most effective treatments for insomnia were over 20 years old.

    一些治療失眠最有效的方式竟都有超過20年的歷史

  • When I shared this with one of my clients, his response caught me off-guard.

    當我向一位病患講述這件事時,他的反應讓我措手不及

  • He said, "Why is it then that you are my last stop, when you should have been my first stop?"

    他說:「為什麼那是你的最後一站,你應該要是我的第一站呀!」

  • The night of sleeplessness here and there is actually normal.

    晚上去睡覺是很稀鬆平常的事

  • Losing sleep over a broken heart - normal.

    在心碎的時候失眠——很正常

  • Losing sleep because your mind pops awake with one more idea

    你因為想著還有其他點子,

  • to add it to your big presentation tomorrow - normal.

    可以加到明天的演說上,所以失眠了——很正常

  • But hopefully, we also know how great it feels to have a really good night of sleep.

    但是,幸好,我們也還知道擁有一覺好眠是多麼棒的一件事

  • And because I know how great it is to have a good night of sleep,

    因為我知道可以好好睡一覺的感覺有多棒

  • I am always struck with wonder

    所以當你講到健康與整體壽命的議題時

  • that sleep only recently has joined the conversation when you talk about health and overall longevity.

    我總是對於「睡眠竟是最近才被加進這個話題中」感到驚奇

  • People even sometimes ask me,

    人們有時甚至會問我

  • "Isn't there some way I can hack into my sleep,

    「沒有什麼方式是我可以駭進我的睡眠中

  • to somehow squeeze it down significantly,

    大大地壓縮睡眠階段

  • so that I can just maybe go straight into, you know, the good stages, where the benefits are?"

    這樣就能直接到達對我有益的良好睡眠階段?」

  • Fair enough. Good question. The answer is no.

    非常好,好問題。但答案是沒辦法

  • (Laughter)

    (笑聲)

  • It turns out a great deal of housekeeping is taking place while we sleep.

    這會變成,當我們處於睡眠狀態時,有很多家事正在運作

  • And sleep is much more complex than just a lack of consciousness.

    睡眠這件事比單單沒有意識還要更複雜

  • When you get into bed, and you pull up the covers,

    當你上床並拉上你的被子

  • and you rest your head on the pillow,

    將你的頭躺在枕頭上休息

  • with your exhale of all the concerns for the day.

    隨著呼氣使整天下來的擔憂散出

  • As you close your eyes, sleep begins to unfold in a series of stages

    當你閉上眼睛時,睡眠就開始展開成一系列的階段

  • that increase in depths as the night goes on.

    隨著夜深而增加深層度

  • All those stages work together

    這些階段都是一同運作

  • to orchestrate all the processes that are needed to derive all the benefits of sleep.

    來協調出睡眠所有好處所需的全部過程

  • For example, we know that sleep is incredibly important for immune functioning.

    例如,我們知道睡眠對於免疫系統來說極為重要

  • Get a lot of consistent sleep, you're more likely to resist infection.

    有了良好的睡眠,就比較能對抗感染

  • If you get sleep while you're sick, you're more likely to recover.

    如果在生病時睡一覺,會比較容易復原

  • Recent evidence suggest that your brain even has its own dedicated waste removal system,

    近代的證據顯示,大腦甚至擁有自己的廢物專用清除系統

  • the glymphatic system.

    膠淋巴系統

  • And this is the system that works primarily while we're asleep

    這個主要運作於我們睡覺的時候

  • to remove the gunk out of our brains that seem to contribute to diseases such as dementia.

    來將看起來會讓你生病,例如癡呆症的泥流,清除到我們的大腦之外

  • So really there is no consensus about why we sleep.

    因此,對於我們為什麼會睡覺並沒有一致的解釋

  • We don't really know why we spend the third of our life doing it,

    我們並不十分了解,為什麼我們花了三分之一的人生來做這件事

  • but one thing that I can tell you

    但,我可以和你說的一件事是

  • is just as the three trimesters of pregnancy can't be whittled down

    就像懷孕三個月不能只為了想要

  • to a convenient three months,

    有自由的三個月而墮胎

  • it seems like sleep and the benefits of it also have an optimum period of gestation,

    睡眠還有睡眠所帶來的好處也有最適合的孕育期

  • which appears to be about 7-9 hours.

    大概是7到9個小時

  • So, while some people are looking to get rid of sleep,

    當有些人正追尋著不要睡覺

  • there are other people that would do anything to get more of it.

    此時,有另一批人會試著做任何事情,只為了多睡一些

  • To them, sleep is not consistently rejuvenating, satisfying,

    對於他們而言,睡眠沒辦法復原、滿足

  • it doesn't leave them ready to go.

    它無法讓他們準備好並出發

  • This is insomnia.

    這就是失眠

  • Now, that word doesn't always resonate with people.

    這個詞無法總是讓人們產生共鳴

  • If you ask them, they're saying, "No, no, I don't have insomnia."

    如果你去問他們,他們會說:「不,不,我沒有失眠」

  • "I just don't sleep."

    「我只是不睡覺」

  • "I don't look like this guy, so how bad off can I be?"

    「我看起來又不像這個怪人,我會變得多糟?」

  • It turns out a diagnosis of insomnia doesn't depend on how bleary-eyed you are,

    結果證明,一份失眠診斷書,不是仰賴於你看起來多睡眼惺忪

  • or even on the number of hours of sleep that you get.

    或是你睡了多少個小時

  • If you consistently don't feel as if your sleep is rejuvenating,

    如果你一直不覺得你的睡眠有讓你休息復原到

  • or if more days that not you feel as if you're having a hard time falling asleep, staying asleep,

    或是,如果有很多天,你都覺得好像很難入眠、熟睡

  • or you're unintentionally waking up too early,

    或是你無意中的太早起床

  • maybe you should get it checked out.

    也許你應該去檢查看看

  • And don't fall into the trap of thinking that whatever is happening with you,

    還有,不要掉進陷阱中 ——

  • that it makes sense that you have some chronic sleep loss.

    讓自己以為「無論身上正在發生什麼都很合理,自己只是有一些慢性睡眠障礙」

  • Until recently,

    直到近期

  • sleep problems that occurred in the context of major life stress,

    在主要生活壓力、醫學或精神病學條件下發生的睡眠問題

  • or medical or psychiatric conditions was largely ignored.

    很大程度上都被忽視

  • It was thought that if some sort of medical issue would be resolved,

    一般認為,如果某些類型的藥物問題可以被解決

  • that eventually sleep would fall into place.

    那睡眠最終即可水到渠成

  • That is clearly not what happens.

    但顯然事情不是照這樣進行的

  • Sometimes, even when the primary issue is resolved, insomnia persists.

    有時候,即使主要的問題已經解決了,失眠依然持續

  • And the reason for that is that insomnia and a lot of other symptoms are mutually exacerbating.

    原因是失眠和很多其他的症狀是一同惡化的

  • What that means is that they're intertwined.

    意思是兩件事是互相交纏的

  • Take, for example,

    例如

  • that half of the 18 million Americans who have major depressive disorder,

    在備受嚴重抑鬱症所苦的一千八百萬個美國人中,有一半的人

  • also have insomnia.

    也有失眠的困擾

  • If you intervene at the level of depression,

    如果從抑鬱介入治療

  • you might get symptom relief,

    或許可以讓症狀緩解

  • and yet, the insomnia can persist.

    然而失眠可能會持續下去

  • But the evidence linking the relationship between insomnia and depression suggest that

    但連結失眠和抑鬱之間關係的證據顯示出

  • if you intervene on the level of sleep,

    如果從睡眠這塊介入治療

  • that people can get relief from those symptoms of depression,

    人們在抑鬱上的症狀則能得到舒緩

  • and you can even prevent further episodes.

    甚至可以預防更多的插曲

  • Insomnia is not just a symptom; insomnia is a disorder.

    失眠不僅僅是一個症狀,它還是一個失調的現象

  • And when it occurs, it should be assessed and treated as the first-line problem.

    當它發生時,它應該要被視為最主要的問題

  • Now, when people do seek treatment, they usually receive a medication,

    現今,當人們想尋求治療時,他們往往都可以得到藥物治療

  • and medications are great.

    藥物治療的療效是好的

  • If you have a stressful meeting with your boss tomorrow, pop a pill;

    如果你明天和老闆有個讓你壓力頗大的會議,吃下一粒藥

  • you're going to sleep tonight.

    那你今晚就可以安心入睡

  • But oftentimes, people don't want to have to rely on anything,

    但是,時常,人們都不想要依賴任何事物

  • especially over the long term, in order to get a good night of sleep.

    尤其是很長的一段時間,只為了得到一夜好眠

  • I have good news,

    我有個好消息

  • and that is that healthy sleep is largely shaped by the things that we do,

    那就是,好的睡眠是由我們所做的事情、

  • by our choices, by our behaviors.

    藉由我們的選擇、行為來塑形的

  • So in this way, the best sleep medicine is our behavior, behavioral medicine.

    所以就這樣來看,最好的睡眠良藥是我們的行為,行為醫學

  • Cognitive behavioral therapy for insomnia,

    失眠的認知行為療法

  • which is a really long name for a treatment, let's just call it CBTI,

    對於療法而言,這真的是個很長的名字,我們就簡稱它為「CBTI」

  • has a substantial evidence-base for the treatment of insomnia.

    它對失眠有實質上的循證治療

  • And we know that not only does it work for most people,

    由此我們知道,它不只對大多數人有用

  • there are several different patient populations that can derive benefit:

    還有很多不同的患者也可以從中獲益

  • cancer survivors, people with PTSD,

    癌症倖存者、創傷後壓力症候群、

  • chronic pain, fibromyalgia, major depression.

    慢性疼痛、纖維肌痛症、憂鬱症等的患者

  • Here, there is consensus.

    看一下這裡,這之間有連貫性

  • CBTI should be the first line of treatment when it comes to insomnia.

    當遇到失眠時,CBTI 應該要是第一線的治療法

  • And why is that?

    為什麼呢?

  • Why would something like therapy cure something that feels like a very physiological need?

    為什麼行為療法能用來治療一個感覺起來很生理上的需求呢?

  • Well, in order to understand why CBTI works,

    為了瞭解為什麼 CBTI 可以成功運作

  • you need to know a little bit about why acute insomnia becomes chronic,

    你需要了解一下為什麼嚴重的失眠會變成慢性症

  • and has a lot to do with our behaviors.

    還有,它和我們的行為有很大的關聯

  • The seemingly benign decisions we make in order to try to fix insomnia,

    我們做出一個為了治療失眠,看起來是良好的一個決定

  • actually perpetuate it.

    但它事實上讓失眠永久存在

  • I blame our instincts. Let me give you an example.

    我把這歸咎於我們的本能,讓我舉個例子

  • If you sustain an injury,

    如果你忍受一個傷痛

  • you automatically apply pressure to any sort of bleeding wound.

    你會自動的壓住任何種類的流血傷口

  • In this case, your instincts are helpful.

    在這種情況之下,你的本能是有幫助的

  • But let's say you're going on a hike,

    但是,當我們將背景換成你正要去健行

  • and it's a beautiful Colorado day,

    天氣晴朗美麗

  • and you run into a bear.

    而你恰巧遇到一隻熊

  • Every cell in your body mobilizes to react to your instinct to turn around and run.

    你身體裡的所有細胞開始竄動,讓你的本能反射性地想要立刻掉頭逃跑

  • Your instincts are wrong.

    但你的本能錯了

  • The bear will chase you, the bear will outrun you,

    這隻熊會追著你跑,接著,牠會超越你

  • the bear will catch you, and then

    抓住你,然後...

  • Well, it turns out the way your instincts should have told you to do

    然而,原來你的本能應該給你的反應是

  • is to make yourself look bigger,

    讓你自己想辦法看起來比較龐大、

  • to stand tall, to puff out your chest, and talk to it on a loud voice,

    站高、鼓起你的胸膛、並大聲的向熊說話

  • and in the very unlikely scenario where the bear actually attacks you,

    在不太可能發生的情境下,假設熊真的對你展開攻擊了

  • what you're supposed to do is pick up a stick and fight back.

    你應該做的,是撿起樹枝並回擊

  • So… (Laughter)

    所以...(笑聲)

  • So this is the same thing that happens with sleep loss:

    所以這和失眠是同樣的事情:

  • we compensate for sleep loss because it tends to make sense to us.

    因為本能使我們想補眠

  • So what do we do?

    所以我們都做了什麼?

  • We doze off on the couch, we go to bed early, we sleep in late,

    我們在沙發上打瞌睡,有時早早去睡覺,有時又很晚睡

  • we have an irregular sleep schedule,

    我們的睡眠周期是不規律的

  • we become really preoccupied with whether or not we'll be able to sleep,

    我們變得為了是否睡得著、

  • whether we've lost the ability to sleep,

    是否失去睡眠的能力

  • and this leads to a lot of hyper arousal, which is where CBTI comes in.

    而分心,導致我們處於高度緊張的狀態,而這時 CBTI 就可以派上用場

  • So there are several different components of CBTI

    CBTI 有很多不同的組成成分

  • that are tailored to each individual person.

    它們會因人而異,量身訂做

  • But in brief, what happens with sleep restriction is it takes someone's existing sleep debt

    簡短來說,睡眠限制是為了合併睡眠的片段

  • and grows it a little bit in order to consolidate sleep,

    而讓某人現存的睡眠債累積多一點

  • so that people fall asleep faster, and they're less likely to wake up.

    因此,人們就會快速入睡並且不易醒來

  • Stimulus control likes to strengthen the relationship between bed being a place for sleep,

    刺激控制則是用來強化「床是作為睡覺的地方」的關聯

  • rather than other engaging activities,

    而不是做其他事的地方

  • such as checking your email, plotting revenge, worrying, stress,

    像是查看你的電子郵件信箱、規劃報復、憂慮、備感壓力

  • or whatever else it might be.

    或是任何其他的事情

  • (Laughter)

    (笑聲)

  • Cognitive therapy helps people identify strategies

    認知療法幫助人們辨別策略

  • that might be able to help them distance themselves from a mind that doesn't seem to be able to turn off.

    這或許可以幫助他們遠離一些看似揮之不去的想法

  • How do they stuck up?

    它們要如何堅持?

  • How do medications and cognitive behavioral therapy compare with one another?

    藥物和認知行為療法如何相互比較?

  • Well, the evidence is in, and the results are clear.

    證據顯而易見,結果也很明確

  • In the short run, CBTI and medications are equivalent,

    在短期之內,CBTI 和藥物治療的功效差不多

  • but in the long run, CBTI is the clear winner.

    但以長久來說,CBTI 很明顯的是個贏家

  • The problem with behavioral therapies is not a lack of evidence that they work;

    行為療法的問題,並不在於沒有證據可以證明他們的功效

  • it is a lack of awareness that they exist.

    而是他們的存在不受重視

  • You could probably rattle off the names of several different sleep medications,

    你或許可以滔滔不絕地說出,許多不同睡眠藥物的名稱

  • but how many commercials have you seen for CBTI?

    但你在廣告上看過多少關於 CBTI 的廣告呢?

  • If you have insomnia, take heart.

    如果你有失眠的狀況,請振作起來

  • The odds are squarely in your favor.

    這個機會很明確地對你有利

  • Your sleep can get better.

    你可以睡得更好

  • You can wake up rejuvenated, with mental clarity,

    你可以內心清明、精神奕奕地起床

  • who knows, maybe even enough energy to stand up to a bear.

    誰知道呢,或許有足夠的力量可以戰勝熊

  • (Laughter)

    (笑聲)

  • But here, I think that what I'll do is I will heed the advice of a great mind,

    在這裡,我想我會做的是留意於一位偉人的建議

  • who says that it's more important to know what sort of person has a disease

    他說過,知道哪種類型的人會有疾病

  • than to know what sort of a disease a person has.

    比知道一個人有哪種疾病還要重要

  • So, I know sleep science, but I don't know you.

    因此,我研讀睡眠科學,但我不了解你

  • We just met.

    我們只是見過

  • I don't know you or the relevant medical history

    我不瞭解你,或你的相關用藥史

  • that would have helped me design a treatment to help you cure your insomnia,

    而它能幫助我設計出治療你失眠的療程

  • But I can leave you with this:

    但我可以留給你這個:

  • eat healthy, exercise, take care of your body,

    吃得健康、適當運動、照顧好你的身體

  • and do all that you can do to cap it all off with a night of great sleep.

    並且做你所有做得到的事,來得到一場好眠

  • Thank you.

    謝謝

  • (Applause)

    (掌聲)

The early part of my career as a clinical psychologist

在我最初的職涯中,我是一名臨床的心理學家

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B1 中級 中文 美國腔 睡眠 失眠 治療 療法 本能 睡覺

TEDx】理解 "如何才能睡得更好"|Vyga Kaufmann博士|TEDxBoulder (【TEDx】Understanding "How do I Sleep Better" | Dr. Vyga Kaufmann | TEDxBoulder)

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    程名豪 發佈於 2021 年 01 月 14 日
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