【五分钟科普】睡眠障碍 (Sleep Disorder)
睡眠障碍困扰你吗？你知道除了失眠（Insomnia）之外，嗜睡症（Narcolepsy）、不安腿综合征（Restless Legs Syndrome）和睡眠呼吸暂停症（Sleep Apnea）也属于睡眠障碍吗？我们邀请到了来自哥伦比亚大学社会工作学院的马博妍小姐姐，来做一期科普。
全文阅读时长约为5-6分钟。
此篇文章不作为任何个体心理健康诊断、治疗与评估的依据，仅作科普，如有需求，请寻求在你所在地区的执业心理咨询师进行进一步评估治疗。
01.
什么是睡眠障碍 (Sleep Disorder)？睡眠有多重要？
睡眠障碍（Sleep Disorder）是会影响睡眠或阻碍我们安稳睡眠的疾病。睡眠障碍会直接影响睡眠质量、入睡时间和睡眠时长等，且间接影响第二天身体的正常工作。睡眠障碍通常与身体或心理健康状况有关，例如抑郁、焦虑或认知障碍等心理疾病。在几种不同类型的睡眠障碍中，失眠（Insomnia）是最常见的一种。其他睡眠障碍包括嗜睡症（Narcolepsy）、不安腿综合征（Restless Legs Syndrome）和睡眠呼吸暂停症（Sleep Apnea）。睡眠障碍既可能导致或加剧恶化心理健康问题，也可能是一些心理健康问题的表现症状。
人体遵循24小时重复的昼夜规律，我们可以理解为一个内部时钟。 这个时钟由两种因素控制：（1）外部因素，比如睡眠环境的光亮和黑暗，（2）可以促进和维持我们睡眠的内部因素，比如遗传基因及神经系统 (Viens, 2019)。我们每个人或多或少都会遇到睡眠问题。 但是，如果出现以下情况，你可能已经患有睡眠障碍：
经常难以入睡 You regularly experience difficulty sleeping.
在夜晚睡满7小时后，第二天仍然感觉很疲惫 You are often tired during the day even though you slept for at least seven hours the night before.
执行日常日间活动的能力降低或受损 You have a reduced or impaired ability to perform regular daytime activities.
经常睡眠不足或睡眠质量差不仅仅会导致疲倦，还会影响认知功能，这可能会进一步导致记忆力减退、儿童学习障碍、改变性格和出现抑郁的症状。长时间睡眠不足的人会更难做决定、易怒、表现不佳、反应迟缓，从而发生交通事故和工伤事故的风险会更高。 睡眠不足还会导致肥胖、糖尿病和心脏病，从而对生活产生不利影响 (Cleveland Clinic, 2020)。
02.
睡眠障碍有多普遍？
我们中的很多人都会经历睡眠不足。在美国，将近 30% 的成年人每晚睡眠时长少于 6 小时，而只有大约 30% 的高中生在上学的时候可以保证每天至少 8 小时睡眠，且超过 5000 万美国人患有慢性睡眠障碍 (Centers for Disease Control and Prevention, 2017)。大约35% 的美国人认为他们的睡眠质量“很差” 或“一般” (National Sleep Foundation, 2014)。
根据《中国睡眠研究报告2022》表明，中国人的平均睡眠时长从2012年的8.5小时减少到2021年的7.06小时，在这大约十年间，中国人平均睡眠时长减少了1.5小时。 只有 35% 的中国人每晚可睡满8小时 (Global Times, 2022)。中国睡眠研究会（CSRS）近期发布的一份睡眠研究报告显示，近年受疫情影响，中国人入睡时间向后延长了两到三个小时，目前有超过3亿中国人患有睡眠障碍 (Global Times, 2021)。
一项针对谷歌关键词搜索的研究表明，在2004-2019年期间，美国和全球关于睡眠障碍的关键词的搜索量呈上升趋势，其中不排除COVID-19疫情的影响 (Zitting et al., 2021)。
在美国，将近 30% 的成年人每晚睡眠时长少于 6 小时，而只有大约 30% 的高中生在上学的时候可以保证每天至少 8 小时睡眠。说的是你吗？
03.
睡眠障碍的主要分类
失眠（Insomnia）
失眠是一种常见的睡眠障碍。失眠患者会难以入睡、难以保持入睡、或睡眠质量不高。即使时间充裕且周围环境适宜睡眠，这些失眠问题也可能会出现。失眠会影响日常生活，在白天使人疲惫。短期失眠可能是由环境或日程安排的改变引起的，通常会持续几天或几周。而每周有三天及以上的失眠现象被称为长期失眠，通常会持续三个月以上，且无其它健康问题因素 (NIH, 2022)。
常见症状
躺下长时间难以入睡 You may lie awake for a long time before you fall asleep. This is more common in younger adults.
睡眠时间短 Sleep may be possible for only short amounts of time. You may wake up often during the night or be awake for most of the night. This is the most common symptom and affects mostly older adults.
经常在清晨醒来 Waking up too early in the morning and not getting back to sleep is also common.
睡眠质量差 Poor-quality sleep may lead you to wake up feeling unrested, and you may feel sleepy during the day. You may also have trouble focusing on daily tasks. Insomnia can cause you to feel anxious, depressed, or easily annoyed.
一些帮助入睡的tips
制造一个适宜睡眠的环境 Make your bedroom sleep friendly. Sleep in a cool, quiet, dark place. Avoid watching TV or looking at electronic devices, as the light from these sources can disrupt your sleep-wake cycle.
形成规律睡眠 Go to sleep and wake up around the same time each day, even on the weekends. If you can, avoid a schedule that changes or other things that may disrupt your sleep schedule.
避免睡前摄入咖啡因、尼古丁和酒精 Avoid caffeine, nicotine, and alcohol close to your bedtime. Although alcohol can make it easier to fall asleep, it can cause you to have a sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.
白天进行规律的运动 Get regular physical activity during the daytime, at least 5 to 6 hours before going to bed. Exercising close to bedtime can make it harder to fall asleep.
下午避免午睡 Avoid naps, especially in the afternoon. This may help you sleep longer at night.
规律饮食 Eat meals on a regular schedule and avoid late-night dinners.
控制睡前饮水量 Limit how much you drink close to bedtime. This may help you sleep longer without having to use the bathroom.
尝试一些缓解压力的新方法 Learn new ways to manage stress. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath. Your doctor may also recommend massage therapy, meditation, or yoga to help you relax. Acupuncture may also help improve insomnia, especially in older adults.
制造一个适宜睡眠的环境说来容易做来难啊…
嗜睡症（Narcolepsy）
嗜睡症是一种慢性神经系统疾病。嗜睡症患者醒来后可能会感到身体得到了休息，但在一天中的大部分时间里还是会感到非常疲倦。许多嗜睡症患者也会经历睡眠中断，从而导致夜间频繁醒来。嗜睡症会影响日常活动。即使嗜睡症患者正在开车、吃饭或谈话时，他们也可能会不自觉地入睡。其他症状可能包括在清醒时突然肌肉无力，使人无法活动（猝倒 Cataplexy）、产生梦境般的幻觉，以及在入睡前或刚醒来后完全瘫痪（睡眠瘫痪 Sleep Paralysis）(NINDS, 2023)。
常见症状
白天睡眠过多 Excessive daytime sleepiness (EDS) – All individuals with narcolepsy have EDS, and it is often the most obvious symptom. EDS is characterized by persistent sleepiness, regardless of how much sleep an individual gets at night.
肌肉突然无力（猝倒症）Cataplexy – This sudden loss of muscle tone while a person is awake leads to weakness and a loss of voluntary muscle control. It is often triggered by sudden, strong emotions such as laughter, fear, anger, stress, or excitement. The symptoms of cataplexy may appear weeks or even years after the onset of EDS. Some people may only have one or two attacks in a lifetime, while others may experience many attacks a day.
入睡或醒来时短暂地无法活动和说话（睡眠瘫痪）Sleep paralysis – The temporary inability to move or speak while falling asleep or waking up usually lasts only a few seconds or minutes and is similar to REM-induced inhibitions of voluntary muscle activity.
出现幻觉 Hallucinations – Very vivid and sometimes frightening images can accompany sleep paralysis and usually occur when people are falling asleep or waking up. Most often the content is primarily visual, but any of the other senses can be involved.
即使嗜睡症患者正在开车、吃饭或谈话时，他们也可能会不自觉地入睡。
不安腿综合征（Restless Legs Syndrome）
不安腿综合征 (RLS)是一种神经系统疾病，RLS会使患者不由自主的活动双腿。发病时间通常在下午或傍晚，在晚上休息时发病最频繁且最严重。 RLS 会严重扰乱睡眠，使患者难以入睡或难以醒来后再次入睡。活动腿部通常可以短暂地缓解不适，但一旦停止活动，腿部不适的感觉通常会再次出现。RLS 是一种睡眠障碍，因为病情通常在休息和试图入睡时发作，同时，RLS也是一种运动障碍，因为患者需要被迫活动腿部来缓解不适症状 (NIH, 2023) 。
常见症状
休息时双腿感觉不适 Sensations that begin after rest – They typically occur when you are inactive and sitting for extended periods (e.g., when taking a trip by plane or watching a movie).
活动双腿后症状得到缓解 Relief of discomfort with movement – You may need to keep your legs (or other affected parts of the body) in motion to minimize or prevent the sensations. You might need to pace the floor or constantly move your legs while sitting.
不适症状明显在夜间加重 Worsening of symptoms at night with a distinct symptom-free period in the early morning – You might have difficulty falling asleep and staying asleep. You may also note a worsening of symptoms if your sleep is further reduced by events or activity.
RLS 是一种睡眠障碍，因为病情通常在休息和试图入睡时发作，同时，RLS也是一种运动障碍，因为患者需要被迫活动腿部来缓解不适症状 (NIH, 2023) 。
睡眠呼吸暂停症（Sleep Apnea）
睡眠呼吸暂停症是一种在睡眠时呼吸暂时停止的疾病。睡眠呼吸暂停症会使人在睡觉时多次呼吸暂停后重新开始呼吸，因为身体不能获得足够的氧气（NIH，2023）。在这种情况下，大脑会试图进行强制唤醒并强制呼吸，但这会极大地影响睡眠质量。随着时间的推移，这种情况会导致其它严重的并发症产生 (Cleveland Clinical，2023)。
常见症状 (Cleveland Clinical, 2023)
醒来时疲惫不堪 Feeling tired or even exhausted when waking up. Even after a full night’s sleep, people with sleep apnea commonly feel extremely tired.
白天犯困 Daytime sleepiness. In more severe cases, this can cause drowsiness during driving, working or other activities.
打鼾 Snoring. This is a common feature with sleep apnea (but it isn’t something that happens in all cases). You can also have sleep apnea without snoring at all.
情绪变化 Mood changes. Depression and anxiety are common symptoms of sleep apnea.
大脑功能受损 Disruptions in brain function. These can include memory loss, trouble concentrating or other brain-related issues.
夜间频繁醒来 Waking up repeatedly in the middle of the night. This symptom might be harder to notice because people usually don’t remember waking up or why they woke up. People who do this often remember waking up for another reason, like heartburn or needing to go to the bathroom.
有明显入睡后呼吸暂停的症状 Pauses in breathing while asleep that others witness. A spouse, partner or other loved one may notice these symptoms while you’re asleep.
呼吸频率不正常 Unusual breathing patterns. Cheyne-Stokes breathing (CSB) is a distinctive breathing pattern that can happen with central sleep apnea. CSB causes fast breathing that gets deeper and then shallower again until breathing stops altogether. After not breathing for several seconds, they’ll start breathing again, then, starting the pattern all over again.
失眠 Insomnia.
夜间出汗 Night sweats and feels restless at night.
性功能障碍 Sexual dysfunction.
醒来后胸闷气短 Waking up feeling short of breath or like you’re choking.
醒来后头疼 Headaches, especially when waking up.
04.
常见治疗方法 (Cleveland Clinic, 2020)
进行心理咨询，找到合适的释放压力的方法 Counseling: Some sleep specialists recommend cognitive behavior therapy. Such counseling helps you “recognize, challenge and change stress-inducing thoughts” that can keep you awake at night.
遵医嘱使用药物治疗 Medications and/or supplements.
失眠可使用帮助睡眠类的药物，比如褪黑素、唑吡坦等安眠类药物 Sleep aids may be helpful in some cases of insomnia, including melatonin, zolpidem, zaleplon, eszopiclone, ramelteon, suvorexant, lamborexant, or doxepin.
不安腿综合征可使用抗癫痫类药物，比如加巴喷丁等 Restless legs syndrome can be treated with gabapentin, gabapentin enacarbil, or pregabalin.
嗜睡症可使用兴奋剂或促进清醒类的药物进行治疗 Narcolepsy may be treated with a number of stimulants or wake-promoting medications, such as modafinil, armodafinil, pitolisant and solriamfetol.
做好睡前准备，制定一个规律的睡眠时间表 Practice sleep hygiene such as keeping a regular sleep schedule.
进行规律锻炼 Get regular exercise.
降低噪音 Minimize noise.
调暗灯光 Minimize light.
把卧室调至舒适的室温 Manage the temperature so that you’re comfortable.
如果你或你认识的朋友有心理咨询需求，欢迎通过下面的链接联系我们，预约心理咨询。
参考文献
Centers for Disease Control and Prevention. Insufficient Sleep is a Public Health Problem. Accessed March 2023.
Clinic, C. (2020, December 23). Common sleep disorders: Symptoms, causes & treatment. Cleveland Clinic. Retrieved March 21, 2023, from https://my.clevelandclinic.org/health/articles/11429-common-sleep-disorders
Clinic, C. (2022, November 15). Sleep apnea: What it is, causes, symptoms & treatment. Cleveland Clinic. Retrieved March 27, 2023, from https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea
National Sleep Foundation. Sleep Health Index. 2014.
NIH. (2022, March 24). What is insomnia? National Heart Lung and Blood Institute. Retrieved March 22, 2023, from https://www.nhlbi.nih.gov/health/insomnia
NIH. (2022, March 24). What is sleep apnea? National Heart Lung and Blood Institute. Retrieved March 27, 2023, from https://www.nhlbi.nih.gov/health/sleep-apnea
NIH. (2023, February 7). Restless legs syndrome. National Institute of Neurological Disorders and Stroke. Retrieved March 26, 2023, from https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome
NINDS. (2023, January 20). Narcolepsy. National Institute of Neurological Disorders and Stroke. Retrieved March 22, 2023, from https://www.ninds.nih.gov/health-information/disorders/narcolepsy
Times, G. (2021, February 1). Epidemic delays sleep by 2-3 hours; 300m chinese suffer sleep disorder: Research. Global Times. Retrieved March 21, 2023, from https://www.globaltimes.cn/page/202102/1214583.shtml
Times, G. (2022, March 22). Average sleep time of Chinese people shortened by 1.5 hours compared with a decade ago. Global Times. Retrieved March 21, 2023, from https://www.globaltimes.cn/page/202203/1256467.shtml
Viens, A. (2019, August 9). Visualizing the world's sleeping habits. Visual Capitalist. Retrieved March 21, 2023, from https://www.visualcapitalist.com/visualizing-worlds-sleeping-habits/
Zitting, K.-M., Lammers-van der Holst, H. M., Yuan, R. K., Wang, W., Quan, S. F., & Duffy, J. F. (2021). Google trends reveals increases in internet searches for insomnia during the 2019 coronavirus disease (COVID-19) global pandemic. Journal of Clinical Sleep Medicine, 17(2), 177–184. https://doi.org/10.5664/jcsm.8810
