DREAMING OF A GOOD NIGHT'S SLEEP (dual language)

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DREAMING OF A GOOD NIGHT'S SLEEP  

It is 11.30pm on a Sunday night and a 26-year-old worker has checked into the London Clinic on Harley Street. His private room is plush and spacious but he is not comfortable.

Several dozen electrodes are glued to his head, chest and limbs; elasticated belts circle his torso; and a blood oxygen monitor is clipped to his right index finger.

Alex Webb (not his real name) is here because, according to his girlfriend, he has been behaving oddly in his sleep. He thrashes around as if fighting the bedclothes. He punches the wall or knocks things off the bedside table. Sometimes he'll speak to her angrily before drifting off again. He wakes up with no recollection of these things, exhausted.

“It's bad enough that my id is having conversations with my girlfriend without my knowledge,” he says. “But what concerns me most is that I might harm her.”

Hence the test, a polysomnogram or “sleep study”. It was arranged by Gaby Badre, a consultant at the London Clinic and professor at Gothenburg University, Sweden. He has a hypothesis about Mr Webb's condition, but he needs to prove it. He wants to record the patient's brain activity and analyse the way he dreams.

Polysomnograms have become more widely used in recent years. The number of sleep complaints in western countries is rising sharply, says Dr Louise Reyner, senior lecturer at Loughborough University's sleep research centre, though it is unclear how much of this is down to greater awareness and better diagnostics.

“There's not a lot of evidence to show that sleep quality and quantity is declining,” she says. “What we are finding is that people are doing more complex tasks than they used to, and that sleepiness is affecting their lives adversely to a greater extent.”

Prof Badre believes modern working habits are pushing human physiology to its limits. “For 1,000 years we had a biphasic existence: working in the day, sleeping at night,” he says. “Now we're in a 24/7 culture in which we feel we have to be ‘connected' – to the office, to our family and to our friends – at all times.”

He has treated numerous City workers who are “completely burned out” because they have chosen to sleep less in order to fit other things into their lives, and so have accumulated a massive “sleep debt”.

“We see more young people with chronic sleep debt developing problems such as hormonal defects, decreased immunological function, high blood pressure and cardiovascular problems, increased weight and type-II diabetes,” he says.

Many of these symptoms are linked to a disorder called obstructive sleep apnoea. OSA causes severe breathing difficulties during the night and sleepiness during the day. The higher your bodyweight, the more likely you are to have OSA, which typically causes loud snoring and choking during sleep.

Marianne Davey, a co-founder of the British Snoring and Sleep Apnoea Association, says levels of OSA in the west have risen in line with increased obesity, as well as improved awareness and diagnosis. In the UK an estimated four in 1,000 people now suffer from OSA in comparison with one in 1,000 in 1991, although some surveys suggest the incidence is much higher.

“Being overweight, smoking and drinking are the three main reasons why people snore, so lifestyle is the biggest contributing factor,” she says.

Yet the worst lifestyle choice is to lose sleep deliberately, Prof Badre says. He has seen a small but growing number of clients who abuse drugs in order to stay awake and alert for unhealthy periods of time.

He recently treated a young investment banker who could apparently work for three to five days to complete a deal, before taking a long weekend to recover. He kept himself awake with a drug called modafinil and then put himself to sleep with a hypnotic agent called zopiclone. Both are available only by prescription, but he had ordered them on the internet.

City high-flyers are being lulled into a false sense of security, Prof Badre says. If you keep yourself awake all night, by any method, and work the following day, you will suffer at least from some cognitive dysfunction.

“This could lead to a small injury. Or it could lead you to miss a traffic light. Or it could lead you to make an error in a million-dollar contract,” he says.

Three days after his sleep test, Mr Webb meets Prof Badre for the results. As suspected, the smoking gun is in his brain activity. A healthy sleeper will experience four or five “sleep cycles” a night, between the troughs of deep sleep, when tissue repair takes place, and the peaks of rapid eye movement, when dreaming takes place.

Mr Webb is in REM more than half the night, having feature-length dreams. What is more, he acts out those dreams because, unlike a normal sleeper, his brain is failing to paralyse his body.

The diagnosis is REM behaviour disorder, a condition that can lead sleepers to injure themselves and partners. It is a neurological problem, so his lifestyle is not to blame, but stress can trigger its worst effects.

He is prescribed a mild dose of a sedative called clonazepam to relax his muscles at night so his body can “unlearn” its misbehaviour. He is also taught to restore his “Circadian rhythms”, the daily physiological cyclesthat regulate our sleep patterns. In weeks he is sleeping like a baby.

Mr Webb was lucky. His health insurance covered him for the sleep test – many UK policies do not. He also responded well to treatment. Most importantly, he was alerted to the problem and acted. According to specialists, many of the sleepless are either too embarrassed or unaware to take even these simple steps.

某
个周日的夜间11点30分，26岁的工人亚历克斯•韦布(Alex Webb，非真名)走进了位于哈利街(Harley Street)的伦敦诊所(London Clinic)。他的专用房间豪华宽敞，但他却感到不舒服。

几十个电极安置在他的头部、胸部和四肢；几条松紧带环绕在他的躯干部位；血氧监测仪探头夹在他的右手食指上。

韦布的女友表示，他之所以来看医生，是因为他睡觉时行为怪异。他会在床上乱动，好像在与床单搏斗；他会击打墙壁，或打翻床头柜上的东西。有时，他会与女友生气地讲话，然后再次入睡。但在他疲惫不堪地醒来后，却一点都不记得这些事。

“真是糟糕透了，另一个‘我’竟在我不知情的情况下与我的女友说话，”他表示，“但我最担心的是，我可能会伤害到她。”

因此他进行了这次“多导睡眠图”(PSG)检查，或称为“睡眠研究”。伦敦诊所咨询师兼瑞典哥特堡大学(Gothenburg University)教授加比•巴德雷(Gaby Badre)安排了这项检查。他对韦布的病情有个假设，但需要验证。他希望记录患者的大脑活动，并分析他的做梦方式。

最近几年，“多导睡眠图”得到了较为广泛的应用。拉夫堡大学(Loughborough University)睡眠研究中心高级讲师路易丝•雷纳博士(Dr Louise Reyner)表示，西方国家的睡眠病例数量正大幅增加，不过尚不清楚的是，有多少病例是因为人们更加关注睡眠和有了更好诊断而出现的。

“没有太多证据显示人们的睡眠质量和数量都在下降，”她表示，“我们发现，人们的任务比以前更为复杂，‘磕睡’正在更大程度上给他们的生活带来负面影响。”

巴德雷教授认为，现代工作习惯正将人类的生理机能逼至极限。“1000年来，我们有两种生活状态：白天劳作，夜里睡觉，”他表示，“如今，我们生活在一天24小时、一周7天的全天候文化中，我们感到我们不得不在任何时候都与办公室、家人和朋友‘连接在一起’。”

他治疗过众多伦敦金融城的员工，这些患者“完全筋疲力尽”，原因在于，为了适应生活中的其它事情，他们选择了减少睡眠，累积了大量的“睡眠债”。

他表示：“我们看到更多睡眠长期欠债的年轻人正出现各种问题，例如，荷尔蒙分泌失调、免疫力下降、高血压、心血管问题、体重增加和Ⅱ型糖尿病等。”

其中许多症状与“阻塞性睡眠呼吸暂停”(obstructive sleep apnoea，OSA)障碍有关。这种症状会令人在夜间出现严重的呼吸困难，在白天又会非常困倦。体重越重，患OSA的几率就越高，这会造成睡眠期间的大声打鼾和窒息。

英国打鼾和睡眠呼吸暂停协会(British Snoring and Sleep Apnoea Association)联合创始人玛丽安•戴维(Marianne Davey)表示，在西方，随着肥胖人群数量的增多、相关意识的增强和治疗水平的提高， 确认OSA症状的人数也在增多。在英国，现在有4‰的人患有OSA症，而1991年只有1‰，不过一些调查显示，真实比例远高于这个数字。

她表示：“超重、吸烟和饮酒是打鼾的三大元凶，因此不良的生活方式是罪魁祸首。”

然而，巴德雷教授表示，最糟的生活方式是故意减少睡眠。他已发现，有少量(但越来越多的)客户正借助药品，以求在对健康不利的时间段内保持警醒。

最近，巴德雷治疗了一位年轻的投资银行家。显然，为了完成一笔交易，他可能会连续工作3至5天，而后用一个长周末来恢复。他用一种叫作莫达非尼(modafinil)的药物来保持清醒，然后用一种叫作佐匹克隆(zopiclone)的药物让自己入睡。这两种药都是处方药，但他能从网上订购。

巴德雷教授表示，金融城里有抱负的人正产生一种错误的安全感。不管用何种方法，如果你整夜不睡，然后第二天接着工作，你至少会遇到某种认知功能障碍。

他表示：“这可能会带来小的伤害。或者可能会让你看错交通灯，或者让你在一份百万美元的合同上犯错。”

在进行睡眠测试3天后，韦布约见了巴德雷教授，询问检查结果。正如猜想的那样，他的大脑活动中出现了一些确凿的证据。健康人每晚会经历4个或5个“睡眠周期”，在组织修复期间，会经历深睡眠的波谷，做梦时则是快速动眼的波峰期。

韦布夜里大部分时间都在进行快速动眼运动，还会做长时间的梦。另外，他会在梦中做出动作，因为与一般的睡眠者不同，他的大脑没有让他的身体休息。

巴德雷教授的诊断是，韦布出现了“快速动眼运动障碍”，这种障碍可能使睡眠者伤害他们自己或伴侣。这属于神经问题，因此不能责怪他的生活方式，但压力可以引发最糟糕的症状。

医生给韦布开了小剂量的镇静药，名为氯硝西泮，用来在夜间放松肌肉，让他的身体可以“忘却”他的不当行为。医生还指导他恢复了“生理节奏”，即控制睡眠模式的日常生理周期。几周后，他的睡眠质量就非常高了。

韦布是幸运的。他的健康保险覆盖了这次睡眠检测，但英国的许多医疗保险并不包括这一内容。他也积极配合了治疗。最重要的是，他注意到了这个问题并采取行动。专家们表示，许多睡眠不好的人要么由于太难为情，要么由于没意识到问题的存在，甚至连这些简单的措施也没有做。