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)