你最近睡得好吗？ 6park.com
在新冠疫情——以及无数个难眠之夜——持续了一年之后，显而易见，我们常用的助眠方法不管用了。科学家指出，我们的许多助眠方式实际上都起到反作用，他们推荐了一种听上去有些不可思议的方法：减少而不是增加躺在床上的时间。 6park.com
最近，我一直遭受失眠的困扰。我知道，不止我一个人有这样的问题。今年2月，《临床睡眠医学期刊》(Journal of Clinical Sleep Medicine)网络版上的一篇文章对13个国家的44项研究进行了汇总，结果发现，约有40%的人在疫情期间出现过睡眠问题。 6park.com
疫情已成为引发压力和忧虑的重要来源。我们的日常作息被打乱，从而影响了我们的生物钟。与此同时，社交隔离还造成了一系列心理健康问题，例如抑郁、焦虑。 6park.com
“只有我们的大脑感觉到这个世界是安全的，它才能入睡。”临床心理学家、行为睡眠医学持证专家温迪·特罗克塞尔(Wendy Troxel)说，“而睡眠状态本身就很脆弱。”特罗克塞尔同时还是兰德公司(Rand Corp.)资深行为学及社会科学家 。 6park.com
众所周知，我们应该建立一套良好的睡眠习惯——保持规律的作息；只有睡觉和享受性爱时才上床；睡前不要饮酒，也不要摄入咖啡因，还要避免强烈的光线，同时养成其他健康的睡眠习惯。这些固然重要。然而，美国睡眠医学会(American Academy of Sleep Medicine)近日表示，若想解决长期性失眠，光有这些还不够。在今年2月《临床睡眠医学期刊》网络版的一篇文章中，作者推荐了一系列治疗方式，并将其统称为“失眠症认知行为疗法”(Cognitive Behavioral Therapy For Insomnia，简称CBT-I)。 6park.com
与普通的睡眠问题不同，失眠是一种临床疾病。当你难以入睡或者难以维持睡眠状态，一周出现过三次以上这样的情况，并且超过一个月，而且白天的状态也会受到影响，出现疲劳、情绪变化、注意力难以集中等现象，这就符合了失眠的定义。睡眠专家认为，当睡不着时，你会感到害怕和焦虑，而这正是引发失眠的原因之一。 6park.com
皮茨堡大学(University of Pittsburgh)医学院精神病学教授、睡眠医学专家丹尼尔·J·拜斯(Daniel J. Buysse)指出，失眠症患者的大脑与熟睡人群的大脑在运行方式上就存在差异。拜斯博士分别对正常睡眠人群和失眠人群进行了正电子发射计算机断层（简称PET）扫描。结果发现，失眠者大脑中与自我反省和环境监控有关的脑区在睡眠期间的活跃程度要高于正常睡眠者。 6park.com
专家们表示，具有讽刺意味的是，有时候我们解决失眠的办法恰恰适得其反，助长了失眠。我们开始刻意补觉——晚点起床，白天打个盹儿，晚上早早上床。这些行为减弱了我们的睡意，也就是身体对于睡眠的需求程度。而当我们真正需要睡觉时，却更难入睡了。它还形成了一种恶性循环：在床上躺的时间越长，就越容易产生焦虑和挫败感。过不了多久，我们的大脑就会把“床”和我们躺在床上时感受到的消极情绪联系起来。 6park.com
“这是一种条件反射。”临床心理学家、亨利·福特睡眠障碍研究中心(Henry Ford Sleep Disorders and Research Center)睡眠问题研究员菲利普·程(Philip Cheng)说，“如果你在床上的时候，经常都是处于一种忧心、沮丧、烦闷的状态，久而久之，你的大脑就会觉得，你的床不是用来睡觉的，而是让你产生这些情绪的地方。” 6park.com
CBT-I的重点在于协助我们改变那些帮倒忙的想法和行为，从而打破这一恶性循环。研究显示，它或许可以产生持久性效果——不仅可以解决眼下的睡眠问题，还有助于培养我们的睡眠修复能力。去年11月的《睡眠期刊》(Sleep)网络版登载了程博士及其同事的一项研究，他们发现，与没有接受过CBT-I的人群相比，数年前接受过CBT-I的人群在新冠疫情期间的睡眠质量和心理健康状态都要更好。 6park.com
一般情况下，CBT-I需要接受治疗师的六到八次治疗，但也有简化版疗程，此外也可以自己在家练习网络课程。CBT-I中最重要的一点是“睡眠限制”，也叫“睡眠再训练”，就是要控制你清醒时躺在床上的时间。为了记录这一时间，我们会计算“睡眠效率数据”，也就是你在床上睡着的时间与躺在床上的总时间之比。目标至少要达到85%。 6park.com
若想提高睡眠效率，我们应该在感到困意的时候才上床。（我的悲惨经历让我明白，筋疲力尽与昏昏欲睡并不是一回事。）除非你睡着了，否则不要待在床上。如果睡不着，你应该去另一个房间，把光线调暗，做一些让你放松的事情，但不要过于专注。看看书。（不要打开任何电子屏幕！）做一做填字游戏。听一些舒缓的音乐。 6park.com
每天保持同一时间起床。（没错，周末也不例外。）这么做有助于调节我们的生物钟，同时也避免了睡懒觉的习惯，如果白天睡懒觉，可能会影响我们晚上的睡眠。要想知道应该几点上床，需要算出你晚上真正睡着的时间。然后，用你第二天起床的时间减去这个数字，就得出了你头天晚上上床的时间。（睡眠时间不要少于六个小时。）当睡眠恢复正常后，开始逐渐增加你在床上的时间，每次增加15分钟，试着以此延长睡眠时间。 6park.com
最后，我们需要重新审视自己对睡眠的看法。当我们告诉自己，我们“睡不着”，或是第二天“没法干活”的时候，我们给自己带来了严重的焦虑，这种情绪会进一步破坏我们的睡眠。 6park.com
经历了几个星期的难眠之夜后，我参加了一个网上CBT-I项目，开始记录自己的睡眠。我设定了固定的起床时间（而且我做到了！），白天也尽量保持规律的作息。我开始推迟上床时间——我天生就是夜猫子，但过去我经常强迫自己早点上床，希望可以弥补睡眠时间。现在，如果我上床后睡不着，我会起来看书，直到我的眼皮子开始打架。 6park.com
而且，我也尽量不再让某些想法给自己增加压力，比如我不会再说“今晚我肯定睡不着了”之类的话。 6park.com
这些办法全都起效了，而且效果明显。但我还需要练习。于是最近的一个晚上，上床睡觉的时候，我打开了我的助眠应用程序，点击了一个链接，上面写着“现在请帮我入睡”。随后传出一名男性的声音，他让我在天花板上找一个印记，然后盯着它看。“你要做的是保持清醒。不要闭上眼。”他说。他是在运用一种被治疗师称为“矛盾意向”的技巧——分散我的注意力，让我不要老去想怎么才能睡着这件事。他继续说，“一直看着那个印记，不要去想其他事。” 6park.com
接着，他让我关注自己的眼皮是不是变得越来越重。他告知说，如果此时合上眼，可能会有一种如释重负的感觉。 6park.com
“坚持！坚持！虽然你的眼皮快要撑不住了，但不要闭上眼！”他说，“记住，你现在的目标是要保持清醒。” 6park.com
接下来他说了什么，我就不知道了。我已经睡着了。

助眠技巧


培养良好的睡眠习惯。睡眠时间争取达到七到九个小时。保持固定的起床和就寝时间。卧室应凉爽、安静，光线昏暗为宜。只有睡觉和享受性爱时才上床。睡前避免摄入酒精和咖啡因，也不要做运动。打算睡觉前，提前半个小时到一个小时关闭电子设备。 6park.com
不要刻意补觉。不要太早上床。不要睡懒觉。白天不要打盹儿。这些会减弱你的睡意，让你第二天晚上更难入睡。 6park.com
感到困了再上床。学会区分倦意和困意。（如果你的眼皮快撑不起了，这就是困意。）真正睡着的时长，再加上半个小时，就是你应该待在床上的时间。 6park.com
除非你睡着了，否则不要待在床上。在床上辗转反侧会让你的大脑进一步强化“睡不着”（以及消极情绪）与“床”之间的联系。 6park.com
重新建立白天的作息规律。制定一套晨间惯例。一日三餐按时吃饭。锻炼也尽量安排在固定时间进行（不要太晚）。下班后，散散步。 6park.com
不要破坏自己的生物钟。无论你是夜猫子，还是习惯早起，生物钟都不是那么容易改变的。掌握自己的最佳睡眠时间，然后坚持下去。 6park.com
建立一套睡前程序。就像孩子一样。定好每天收工的时间，然后洗个澡，看看书，让自己放松下来。 6park.com
不要小题大做。不要再跟自己说，你今晚睡不着了，或是你明天没法干活了。想一想是不是真的会这样。换一些积极的想法。（“一晚上睡不好又不是世界末日。”）然后，试着把注意力集中到别的事情上。“那些睡眠状况很好的人从来不想睡觉这件事。”特罗克塞尔说。 6park.com
把你的担忧写下来。“有时候我们之所以会担心，是因为我们的大脑不想让我们忘记某些事。”菲利普·程说。如果你白天把自己担心的事情写下来，“那么到晚上感到担忧的时候，你可以告诉自己，你已经把它们记下来了。” 6park.com
常怀感恩之心。假如你发现自己在床上思来想去，难以入睡，不妨想想那些让你心怀感激的事情，或是回味一下白天你最喜欢的时刻。这会让你的大脑逐渐将“床”和“愉悦的想法”联系在一起。“这可以让我们重新体会到安全感。”艾莉森·哈维(Allison Harvey)说，她是加州大学伯克利分校(University of California, Berkeley)的临床心理学教授，也是睡眠与情绪研究诊所Golden Bear Sleep and Mood Research Clinic的负责人。 6park.com
倾听别人的声音。最好选择一本内容轻松但又不会令人兴奋的有声读物。上床后，把音量调低。这样可以让你不至于陷在自己的想法里。 6park.com
尝试CBT-I。在行为学睡眠医学学会Society of Behavioral Sleep Medicine的网站上，你可以寻找离你最近的治疗师。诸如克利夫兰医学中心(Cleveland Clinic)这样的健康机构和美国退伍军人事务部(Department of Veterans Affairs)也开设了相关项目。此外，研发人员还开发了Sleepio、Somryst这类应用程序。

✎✎✎

How are you sleeping? 6park.com
After one year of a pandemic—and a lot of disturbed slumber—it’s clear that our usual sleep strategies aren’t working. Scientists say many of the things we do to chase sleep are actually hurting us, and recommend a counterintuitive approach instead: Stay in bed for less time, not more. 6park.com
I’ve been battling insomnia lately. I know I’m not alone. Approximately 40% of the population has had sleep problems during the pandemic, according to a meta-analysis of 44 studies from 13 countries published online in February in the Journal of Clinical Sleep Medicine. 6park.com
The pandemic has been a significant source of stress and worry. Our daily routines have been disrupted, affecting our circadian rhythms. And social isolation has led to mental-health problems such as depression and anxiety. 6park.com
“Our brains have to feel like the world is safe and secure to be able to fall asleep,” says Wendy Troxel, a clinical psychologist, certified behavioral sleep medicine specialist and senior behavioral and social scientist at Rand Corp. “Sleep is a vulnerable state.” 6park.com
We all know we’re supposed to have good sleep hygiene—keep a consistent schedule; use the bed for sleep and sex only; avoid alcohol, caffeine and bright lights before bed and practice other healthy sleep habits. This is important. But the American Academy of Sleep Medicine recently declared it’s not enough to solve chronic insomnia. In an article published online in February in the Journal of Clinical Sleep Medicine, it recommended a series of treatments collectively known as cognitive behavioral therapy for insomnia, or CBT-I. 6park.com
Unlike run-of-the-mill sleeping problems, insomnia is a clinical disorder. We have insomnia when we have difficulty falling or staying in sleep three or more times a week, and this lasts a month or longer, leading to daytime consequences, such as fatigue, mood changes or difficulty concentrating. Sleep experts believe insomnia is triggered in part by the fear and anxiety we have about not sleeping. 6park.com
The brains of people with insomnia act differently than the brains of people who are sleeping well, according to Daniel J. Buysse, a professor of psychiatry and sleep medicine specialist at the University of Pittsburgh School of Medicine. Dr. Buysse has conducted PET scans of people who sleep normally and people with insomnia. In people with insomnia, parts of the brain involved with self-reflection and monitoring the environment show higher levels of activity during sleep compared with normal sleepers. 6park.com
Ironically, insomnia is also driven by the things we do to try to solve it, experts say. We start to chase sleep—waking up later, taking naps, going to bed too early. This diminishes our sleep drive, which is our body’s need for sleep. It makes it harder to sleep when we’re supposed to. And it creates a vicious cycle: More time in bed means more opportunity for frustration and failure. Before long, we’ve taught our brain to associate our bed with the negative emotions we feel lying there. 6park.com
“It’s Pavlovian,” says Philip Cheng, a clinical psychologist and sleep researcher at the Henry Ford Sleep Disorders and Research Center. “If you spend a lot of time in bed worried and frustrated and miserable, in time your brain learns that your bed is a place to do all of these things but sleep.” 6park.com
CBT-I focuses on breaking this loop by helping us change the thoughts and behaviors that are counterproductive. Research shows it may have lasting effects—not just fixing our sleep problems in the present but helping us form a sort of sleep resilience. A study conducted by Dr. Cheng and colleagues and published online in November in the journal Sleep found that people who received CBT-I years ago have been sleeping better and have better mental health during the pandemic than those who did not. 6park.com
The treatment is typically six to eight sessions with a therapist, but there is an abbreviated version, as well as online programs to try at home. The primary component is “sleep restriction,” also called sleep retraining, which is limiting the amount of time we spend in bed awake. To track this, we calculate our “sleep efficiency number,” which is the percentage of time we’re in bed that we’re asleep. The goal is at least 85%. 6park.com
To help boost our sleep efficiency, we should avoid going to bed unless we’re sleepy. (I’ve learned the hard way that being bone-weary exhausted is not the same thing as sleepy.) And we shouldn’t stay in bed unless we’re asleep. If we’re having trouble falling asleep, we should go to another room, keep the lights low and do something pleasant but not too absorbing. Read a book. (No screens!) Do a crossword. Listen to some soothing music. 6park.com
We need to wake up at the same time every day. (Yes, weekends too.) This helps regulate our circadian rhythm and keeps us from sleeping late, which would harm our ability to sleep the following night. To figure out when to go to bed, calculate the amount of time you are actually asleep during the night. Then subtract that from the time you need to wake up. That’s your bedtime, for now. (Don’t give yourself less than 6 hours in bed.) As your sleep gets back on track, start lengthening your time in bed slowly, by 15 minute intervals, to try to increase your sleep duration. 6park.com
Finally, we need to challenge our thinking about our sleep. When we tell ourselves we “can’t sleep” or “won’t be able to function” the next day, we’re causing ourselves a lot of anxiety, which further interferes with our sleep. 6park.com
After weeks of having trouble sleeping, I signed up for an online version of CBT-I and started tracking my sleep. I’ve set (and kept!) a consistent wake-up time and have become more careful about sticking to a steady daytime routine. I started going to bed later—I’m a natural night owl but had been trying to force myself to go to bed earlier, thinking I could catch up on sleep. And once I’m in bed, if I can’t sleep, I get back up and read until I feel my eyes starting to shut. 6park.com
I’ve also tried to stop stressing myself out with thoughts such as: “I’ll never sleep tonight.” 6park.com
It’s all helped a lot. But I still need practice. So when I got into bed one recent night, I opened my sleep app and clicked on a link that said “Help me get to sleep now.” A recording of a man’s voice told me to find a mark on the ceiling to focus on. “Your goal is to stay awake. Don’t let your eyes close,” he said. He was deploying a technique therapists call paradoxical intention—in an attempt to distract me from focusing on trying to fall asleep. “Stay focused on that spot,” he continued. 6park.com
Then he told me to notice how my eyelids were getting heavier. He acknowledged that it would probably feel like a relief to close them. 6park.com
“Resist! Resist! Resist the temptation to close your eyes, even as they feel heavier and heavier!” he said. “Remember your goal here is to remain awake.” 6park.com
I don’t know what he said next. I was asleep.

Tips to Help You Sleep


Practice good sleep hygiene. Aim for seven to nine hours of sleep. Keep consistent wake-up and bedtimes. Keep the bedroom cool, quiet and dark. Use the bed for sleep and sex only. Avoid alcohol, caffeine and exercise before bed. Turn off your screens 30 to 60 minutes before trying to go to sleep. 6park.com
Don’t chase sleep. Don’t go to bed early. Don’t sleep late. Don’t nap. You’ll diminish your sleep drive, making it even harder to go to sleep the next night. 6park.com
Don’t go to bed until you’re sleepy. Learn the difference between tiredness and sleepiness. (Sleepiness is when your eyes are drooping.) And limit your time in bed to the amount of time you are asleep, plus half an hour. 6park.com
Don’t stay in bed unless you’re asleep. Tossing and turning in bed reinforces your brain’s association between wakefulness (and negative emotions) and the bed. 6park.com
Re-establish daily routines. Have a morning routine. Eat meals at the same time. Exercise at the same time (not too late). Log off work at the end of the day and take a walk. 6park.com
Stick to your natural circadian rhythm. You’re not going to be able to easily change whether you’re a night owl or an early bird. Recognize when you sleep best and stick with it. 6park.com
Have a bedtime routine. Just like a child. Establish a daily wind-down time. Then take a bath. Read a book. Relax. 6park.com
Stop catastrophizing. Quit telling yourself you won’t be able to sleep, or to function the next day. Ask yourself if these thoughts are really true. Replace them with positive thoughts. (“A bad night of sleep is not the end of the world.”) Then try to focus on something else. “People who sleep well don’t think about sleep all the time,” says Wendy Troxel, a certified behavioral sleep medicine specialist. 6park.com
Keep a worry journal. “Sometimes we worry because our brain is telling us to not forget something,” says Philip Cheng, a sleep researcher at the Henry Ford Sleep Disorders and Research Center. If you write your worries down during the day, “when worry comes at night you can tell yourself you’ve already documented it.” 6park.com
Practice gratitude. If you find yourself starting to ruminate in bed, think about the things you are grateful for, or savor your favorite moments from the day. This will train your brain to associate the bed with pleasant thoughts. “And it gets us back to feeling safe,” says Allison Harvey, a professor of clinical psychology at the University of California, Berkeley, and director of the Golden Bear Sleep and Mood Research Clinic. 6park.com
Listen to someone else’s voice. A pleasant but unexciting audiobook is ideal. Turn it on low volume when you go to bed. This will distract you from your thoughts. 6park.com
Try CBT-I. The website of the Society of Behavioral Sleep Medicine allows you to search for a therapist in your area. Some health programs, such as the Cleveland Clinic and the Department of Veterans Affairs, have programs. And app versions such as Sleepio and Somryst were developed by researchers.