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預防阿爾茨海默,中年起就要做對這件事

預防阿爾茨海默,中年起就要做對這件事

David H. Freedman 2021年08月15日
相關行業即將爆發

去年,米蘭達·林為了照顧三名因新冠疫情而困在家的孩子,經常要忙到深夜才能夠跟上工作進度。她擔心晚睡會影響睡眠,于是開始用iPhone上的應用程序跟蹤睡眠時間。

結果讓她吃了一驚。“ 我發現就寢時間最早晚上9點,最晚可以到凌晨3點。”她說。為了在合理的時間內睡覺,她設置了每天提醒的鬧鐘

作為俄勒岡健康與科學大學(Oregon Health & Science University)的神經學家,以及 VA波特蘭保健系統(VA Portland Health Care System)的睡眠障礙醫師,米蘭達·林很容易理解為什么當發現自己晚間睡眠缺乏時會那么緊張。

近年來,全球研究人員發現,中年人哪怕只是輕微的睡眠不足,都很可能導致阿爾茨海默癥。

米蘭達·林一直在研究前沿,她說:“過去認為我們睡眠問題只是阿爾茨海默癥的癥狀之一。而現在的發現是,睡眠不足可能與導致大腦病變的變化有關。”

研究發現,提升睡眠質量可能是顯著降低老年神經退行性病變風險的最佳方法,可能也是唯一的方法。改善睡眠還有其他的益處,這或將會進一步推動本已火熱的睡眠行業。

在期刊發表睡眠不足與長期神經退行性變的新聯系之前,市場研究公司Infinium Global research預測,目前全球睡眠輔助設備市場包括藥品、設備、專門床上用品和醫療保健服務,預計達到800多億美元,未來五年將攀升至1140億美元。

研究公司BCC預測的增長率與之類似。現在,BCC的生命科學內容主管蒂姆·奧布萊恩表示,該行業“突然躥升”。

行業之所以發展迅速,不僅因為消費者強烈渴望優質睡眠帶來的健康,還有一系列新療法和技術,從睡眠藥物到植入式醫療設備再到智能枕頭,都有利于實現目標。

“現在人們對睡個好覺的關注度與其他健康問題差不多。”谷歌(Google)的Nest智能設備線負責人阿什頓·烏達爾說。“人們都希望獲得幫助。”

大腦干涸

睡眠不好會讓人感覺糟糕,反應也不那么敏銳,這已不是新聞。研究表明,睡眠不足導致13%的工人受傷,由于缺勤和效率降低,平均每位員工導致企業損失3500美元。進入新時區第二天,交通事故上升了10%。

然而,長期缺乏睡眠的人并不少。據估計,入睡或持續睡眠有困難的成年美國人百分比在50%到75%之間,連美國疾病預防控制中心(CDC)都將睡眠不足列為公共流行病。蘭德公司(Rand Corporation)的一份報告估計,由于很多人晚上無法規律睡眠至少6小時,每年給美國經濟造成的損失高達2250億美元,其他機構的研究稱損失高達4100億美元。

針對有些頭條新聞宣稱睡眠過多對健康存在危害的說法,睡眠專家表示不必理會。是潛在的健康問題導致個人需要睡眠的時間達8小時以上,而非睡眠過多導致健康問題。

研究人員提供了一系列新觀點,有助于了解睡眠時間不足或睡眠深度不足的影響。研究表明,睡眠不足會嚴重破壞身體新陳代謝,導致疲勞、體重增加和其他問題。

位于波士頓的布列根和婦女醫院(Brigham and Women’s Hospital)的研究員和醫生、哈佛醫學院睡眠醫學部(Harvard Medical School’s Sleep Medicine Division)的主任查爾斯·澤斯勒稱:“睡眠充足時,不僅心情好,對傷害和疾病的抵抗力也更強,甚至有越來越多的證據表明還能提升在其他人眼中的吸引力。澤斯勒還補充道,越來越多的證據甚至讓軍方重新考慮,是否應該繼續用睡眠剝奪當成強化部隊訓練的手段。

根據行業研究公司PatSnap的數據,過去五年中每年關于睡眠和睡眠障礙的科學期刊文章數量大約翻了一番,2020年達到3000篇。

正因為睡眠對大腦衰老造成長期影響的發現,不僅讓睡眠研究者們議論紛紛,也讓消費者拼命尋找提升睡眠的解決方案。

眾所周知,阿爾茨海默癥患者往往睡眠不好。但數十年,來科學家認為睡眠問題只是該病的癥狀,并沒有將其當成可能的病因或催化劑。

2009年,米蘭達·林和同事們發現,經過基因改造的老鼠患上阿爾茨海默癥之類的疾病后,如果睡眠不足會更快出現該病標志性的腦斑塊。“我們發現,睡眠時斑塊消除非常活躍,而白天不活躍。”她說。

那么,相關發現適用人類嗎?這一關鍵問題一直沒有答案,直到今年兩項大型流行病學研究表明,中年睡眠是否充足,是預測幾十年后是否會患上阿爾茨海默癥和其他癡呆癥的可靠因素。

其中一項連續25年的研究從50歲開始追蹤約8000名英國人,發現每晚睡眠時間不超過6小時的人之后患癡呆癥的風險要高出30%。

《自然》雜志(Nature)4月發表論文的主要作者、巴黎法國國家健康與醫學研究院(Inserm)和倫敦大學學院(University College London)研究睡眠的塞維林·薩比亞指出:“現在我們認為,早年建立良好的睡眠習慣有助于降低患病風險,這點非常重要。我們甚至可以利用睡眠干預,延緩阿茲海默癥病人的病情。”

另一項研究發表在2月的《老齡化》雜志(Aging)上,項目跟蹤了3000名65歲及以上的老人五年,發現平均每晚睡眠時間不到5小時的人患癡呆癥的風險達到睡眠正常者的兩倍。

“過去我們不知道如何降低風險,但現在科學表明改善睡眠可能有效。”布列根和婦女醫院的睡眠科學家、哈佛醫學院講師,也是該研究的主要作者麗貝卡·羅賓斯說。同為該研究作者之一的澤斯勒指出,參與者當中睡眠不良者在研究期間死亡的可能性是睡眠正常者的四倍,動脈硬化發病率是正常者的三倍。

與此同時,米蘭達·林正在努力收集證據,證明在失眠小鼠身上發現的斑塊加速積聚可能也發生在人類身上,如果這一點被證實將會成為確鑿證據。

如果能找到有效的方法減少老年癡呆癥的潛在影響,意義將無比重大。55歲以上的人群有八分之一最終患上阿爾茨海默癥或其他癡呆癥,僅在美國每年就要花費6550億美元的醫療費和其他費用。最近僅有一款治療阿爾茨海默癥的藥通過了美國食品與藥品管理局(Food and Drug Administration)批準,引起了爭議。專家們普遍認為,只有少數患者能享受很小的幫助,代價卻十分巨大。如果公眾意識到中年時保持優質睡眠很可能可以有效避免患病,或將瘋狂注重休息。

藥、泵和脈搏

睡眠行業已蓄勢待發。

很多睡不安穩的人第一反應是和近1000萬美國人一樣,靠處方藥獲得更健康的睡眠,他們每年在處方藥上的總花費超過40億美元。市場上四分之一是安定之類苯二氮卓類藥物,這是一種鎮靜劑,也可以緩解焦慮。

其余大部分是業界所謂的“Z-藥物”,例如唑吡坦(安必恩)、佐匹克隆、扎來普隆和艾司佐匹克隆(舒樂安定),都可以增強促進睡眠的神經遞質GABA,誘導睡眠的副作用通常比其他藥少。

但是,目前研究并沒有對任何現有的安眠藥的長期益處給予肯定。5月發表在《英國醫學雜志》(BMJ)開放版上的一項研究發現,經常服用安眠藥的人在兩年后的睡眠時間并不會比不服藥的人群長。

羅賓斯和同事的一項研究更令人不安,該研究似乎顯示服用安眠藥會加大以后患癡呆癥的風險。羅賓斯指出,該聯系可能與導致測試者因睡眠困難而服藥有關,與安眠藥本身關系不大,不過研究也說明目前人們普遍服用的安眠藥,并不是降低癡呆風險的正確選擇。

“可以說,當前的安眠藥可能會幫助睡眠,但無法獲得自然睡眠的好處。”她說。

研究人員和制藥公司忙于研發新藥,正是因為他們清楚地意識到如果有藥能夠提供自然睡眠的體驗,可能會非常暢銷。東京制藥公司衛材(Eisai)去年推出了Dayvigo,通過阻斷某些幫助人保持清醒的神經遞質從而發揮作用。

“我們找到了最新的作用機制。”衛材負責神經病學業務的神經科學家瑪格麗特·莫林說。“我們正在研究其他可能有效實現目標的神經遞質。”但到目前為止,并沒有證據表明其效果更接近自然睡眠。

特別令人感興趣的是研究如何定位大腦中專門控制深度睡眠階段的回路,這似乎對大腦健康益處最大。麻省大學醫學院(University of Massachusetts Medical School)睡眠科學家克里斯泰勒·阿納克萊及其同事開創的研究表明,刺激小鼠大腦某個稱為面神經旁核(parafacial zone)的區域后,根據老鼠腦電波觀察自然深度睡眠長達6小時,比正常單次睡眠時間長20倍。

阿納克萊說:“我們認為很有可能取得進展,找到刺激人腦類似區域的藥。”她補充說,實驗室也在研究是否老鼠睡眠越深對阿爾茨海默癥抵抗力更強。

與此同時,盡管實際研究并未顯示相關產品對睡眠長期益處多大,仍有很多美國人利用大麻產品促進睡眠。

根據大麻市場研究公司Brightfield Group的數據,72%的大麻服用者報告說“睡前”會來一口,近5000萬嘗試過大麻二酚(CBD)的美國人中,主要目的都是提升睡眠質量。

“過去兩年中,我們確實看到人們對睡眠的興趣上升。”位于丹佛的Balanced Health Botanicals公司的首席增長官克里斯·范·杜森說,該公司在業內相當知名,是CBDistillery的子公司。

范·杜森指出,該公司產品是廣受歡迎的非處方睡眠輔助劑,含有大麻二酚和褪黑素的軟糖,銷量非常好。他補充說,公司馬上要推出一款新產品,將大麻二酚與CBN(另一種非精神病性大麻化合物)結合的軟糖,盡管目前沒有太多用以作為支撐的證據,但據說也能助眠。

另一個巨大的睡眠輔助市場則與睡眠呼吸暫停有關。睡眠呼吸暫停是一種疾病,由于睡眠過程中氣道狹窄或神經信號出現錯誤,患者容易喘不過氣,很難睡安穩。美國約有700萬人被診斷患有呼吸暫停,美國睡眠醫學學會(American Academy of Sleep Medicine)估計患者還有2300萬人,這些人要么自己沒有意識到,要么選擇忽視。

澤斯勒說真正的數字可能更高,他表示未接受充分治療的呼吸暫停患者是受到睡眠健康問題影響最嚴重的人群之一。澤斯勒和同事研究發現,呼吸暫停患者比正常人群出現認知障礙跡象平均早10年,出現阿爾茨海默癥跡象早5年,過早死亡的可能性是正常人的6倍。

“研究人員終于開始敲響警鐘。”他說。

呼吸暫停的主要療法是所謂的CPAP機或類似設備,利用大小合適、半剛性的面罩將空氣泵入患病的肺部。機器價格約為500美元起,由于制造商增加了從定制面罩配件到自動調節雙向氣流到無線采集數據等各種功能,很多機器的起價已經高達3000美元甚至更多。據BCC估計,該機器總體來說已在全球形成近40億美元的市場,美國約有500萬的CPAP用戶。

但當被醫生告知使用CPAP機時,通常約40%的患者會因為預期或實際的不適和麻煩,要么拒絕,要么停止使用。小部分不愿意使用CPAP的患者選擇接受手術,切除口腔后部和喉嚨頂部的組織,但存在并發癥和痛苦恢復的風險,而且緩解癥狀的成功率僅為25%左右。

較新的替代方法是“神經調節”,是門診即可完成的小手術。為患者植入微小的裝置和電線后,夜間感知呼吸并向舌頭發送電脈沖,幫助舌頭彎曲并打開氣道。總部位于明尼阿波利斯郊外的Inspire Medical Systems公司提供了美國食品藥品監督管理局(FDA)批準的唯一一種設備,研究顯示使用該設備的一萬多名患者睡眠呼吸暫停問題減少了79%。

如今,總部位于倫敦的LivaNova已經推出臨床版本。該公司的呼吸暫停相關業務負責人約翰·韋伯認為,睡眠問題的壞消息能夠提升人們對該技術的興趣。“預計公眾認知會出現明顯的高峰。”他說。

追蹤睡眠

對于沒有呼吸暫停癥狀以及希望避免用藥的患者,也有越來越多的產品供他們選擇。

比如200美元的ZelEMA智能枕頭,公司聲稱它能夠人工智能檢測打鼾并學習睡眠模式,自動升高或降低枕頭高度,從而調節氣道優化睡眠。售價70美元的Zeeq枕頭不會改變形狀,但聽到打鼾聲后將振動,或許可以打斷粗重的呼吸。枕頭還能夠播放音樂,控制電燈之類智能家電。

目前“智能睡眠面罩”Luuna在Kickstarter上預購價199美元,可以監測睡眠者大腦的電活動,播放“幾乎由自己腦電波組成”的音樂。

一些“光治療”盒或眼鏡能夠理順晝夜節律,短時間讓眼睛看到明亮的藍光或綠光,從而調節身體內部的定時信號,確保晚間感到困倦。與此同時,喜歡冒險的購物者可以通過Gearbest(向美國銷售和發貨的中國大型在線零售商),嘗試一系列更具異國情調的睡眠小工具。

還有一些設備宣稱能夠向鼻孔發射電能和激光,或利用磁力膨脹鼻孔來改善睡眠。

與安眠藥一樣,相關產品都未得到主流睡眠專家的認可。Inserm的薩比亞指出:“到目前為止,沒有明確證據證明產品的效用。” 另一方面,不管鼻腔激光和磁力如何,似乎也沒人把他們明確劃線。

研究發現不管是從仰睡改為側睡,伴著與深度睡眠腦電波同步的聲音入睡,還是一天當中在特定時間照特定光線,都對睡眠和大腦健康有益,其中的光線療法正是俄勒岡健康科學大學的米蘭達·林對睡眠缺乏患者采取的方式。不過大部分療法的效果尚無定論。

另一方面,針對呼吸暫停以外的睡眠問題,專家幾乎一致推薦一種方法:定期早睡,而且環境要放松。澤斯勒指出:“沒有什么比充足睡眠更重要。”他補充說,睡前一小時左右,最好身處安靜黑暗的房間,想些輕松的事情,保持輕度活動,多數人都會發現失眠有所改善。

美國睡眠醫學學會建議,如果有人需要基本睡眠方法以外的幫助,最好咨詢醫學專家、睡眠培訓師或其他可以提供四到八節“失眠認知行為療法”課程(CBT-I)的從業者,根據提供的練習和策略進一步實現深度睡眠。

睡眠相關服務行業正蓬勃發展,根據美國睡眠醫學會統計,其成員包括約11000位經認證的睡眠中心和醫療專業人員,這只是提供睡眠相關服務的專業人員和醫生當中的小部分,還有不少只是兼職。

如果去診所里進行全面的睡眠檢查,技術人員利用設備監測患者睡眠情況,有些不使用設備也很容易花費數千美元,不過對于睡眠呼吸暫停采取正式診斷可能很有必要。

事實上,有一款設備已獲得多數專家認可,雖然它并不能夠代替睡眠衛生和CBT-I等行為方法,但受眾可以從中獲得更多益處。這種設備就是睡眠跟蹤器,或者能夠監控用戶睡眠時間和深度的電子設備和應用程序,某些情況下還可以提供改進方法。

羅賓斯指出,2018年的一項研究發現,三分之一的成年人已經在用某種設備跟蹤睡眠,目前應接近一半。“如果對自己的睡眠狀況感到好奇,那么在做睡眠檢測之前都應該先試一下。”她說。

最流行的睡眠跟蹤器都是可穿戴設備,如手表或腕帶。市場研究公司IndustryARC估計,目前全球可穿戴睡眠跟蹤器市場價值達30億美元,PatSnap估計未來四年睡眠技術市場年增長率為16%。可穿戴式跟蹤器通常利用光學傳感器監測心率,用加速計監測身體活動,利用相關信息不僅能夠推斷睡眠時間長短,還可以推斷出深度睡眠時間。1月谷歌收購的可穿戴設備制造商Fitbit里負責睡眠研究的科學家康納·赫尼根說,該技術在識別睡眠階段方面的準確率約為70%。赫尼根指出,相比之下,權威標準睡眠實驗室EEG數據的準確率約為95%,該數據通過嵌入電路的頭盔來測量腦電波。

Fitbit的companion應用程序為提升睡眠質量,推薦了一系列建議和鍛煉方式,其中很多包月價格僅為9.99美元,具體內容包括睡眠“打分”,可詳細分析不同類型的睡眠、對何時睡覺和何時起床提供建議、深呼吸和正念鍛煉等。

“有充分證據顯示,相關功能對睡眠確實會有積極的影響。”赫尼根說。他補充說,Fitbit早期的一項研究表明,如果遵照建議,平均每晚能夠多睡15分鐘。他指出,公司正計劃增加打鼾檢測功能,如果可以獲得美國食品與藥品管理局批準,今后也能夠增加睡眠呼吸暫停監測。

蘋果公司(Apple)也在Apple Watch的應用程序中提供睡眠支持功能,包括自定義設置“放松”睡眠程序。可穿戴設備制造商Whoop提供每月30美元的服務,可以根據鍛煉、屏幕使用時間、酒精和咖啡因消耗情況,對增加或減少睡眠時間提供建議。美國海軍的拆彈專家就在試用Whoop,說起工作壓力估計沒有人比得上拆彈專家了,最后發現在設備幫助下平均每晚增加了45分鐘睡眠時間。

除了Fitbit部門外,谷歌也在最新版本的智能帶屏幕音箱“Nest Hub”上添加大量睡眠跟蹤和改善功能,從而大力進軍市場。谷歌的烏達爾說,公司驚訝地發現五分之一的音箱都放在臥室里,所以提出了這一想法。

與此同時,用戶調查表明不少人忽視睡眠跟蹤的主要原因是睡覺戴著可穿戴設備不舒服,有些干脆忘了戴。為了避免用戶不適,新款音箱利用麥克風和雷達從床邊無接觸監測身邊睡眠者的情況,包括胸部的起伏。“有沒有打鼾?是不是踢腿了?周圍環境有什么狀況?”他說。“早上會提供詳細信息,不用主動想著。”他補充說,最終信息是關于睡眠持續時間和質量報告,分為八個部分。

研究可穿戴設備市場的Forrester Research的首席分析師朱莉·阿斯克稱,種種新設備都在吸引消費者,但不要對這些設備期望過高。“技術是能夠幫助改進,到最后人們還是得養成健康的習慣。”她說。“對于努力改進睡眠質量的人們而言,健康的生活習慣最能加速實現目標。”

衛材的莫林表示,有時設備造成的問題比解決的問題多。她說:“如果應用程序告訴你睡得不好,反而可能導致情緒沮喪。”她還指出,醫學上將這種為獲得充足睡眠反而導致壓力過大、失眠更加嚴重的新型睡眠障礙稱之為“orthosomnia”,而智能設備就誘發了更多相關病例。另一方面,睡眠醫生會鼓勵因感到壓力而想辦法改善睡眠。(財富中文網)

譯者:馮豐

審校:夏林

去年,米蘭達·林為了照顧三名因新冠疫情而困在家的孩子,經常要忙到深夜才能夠跟上工作進度。她擔心晚睡會影響睡眠,于是開始用iPhone上的應用程序跟蹤睡眠時間。

結果讓她吃了一驚。“ 我發現就寢時間最早晚上9點,最晚可以到凌晨3點。”她說。為了在合理的時間內睡覺,她設置了每天提醒的鬧鐘

作為俄勒岡健康與科學大學(Oregon Health & Science University)的神經學家,以及 VA波特蘭保健系統(VA Portland Health Care System)的睡眠障礙醫師,米蘭達·林很容易理解為什么當發現自己晚間睡眠缺乏時會那么緊張。

近年來,全球研究人員發現,中年人哪怕只是輕微的睡眠不足,都很可能導致阿爾茨海默癥。

米蘭達·林一直在研究前沿,她說:“過去認為我們睡眠問題只是阿爾茨海默癥的癥狀之一。而現在的發現是,睡眠不足可能與導致大腦病變的變化有關。”

研究發現,提升睡眠質量可能是顯著降低老年神經退行性病變風險的最佳方法,可能也是唯一的方法。改善睡眠還有其他的益處,這或將會進一步推動本已火熱的睡眠行業。

在期刊發表睡眠不足與長期神經退行性變的新聯系之前,市場研究公司Infinium Global research預測,目前全球睡眠輔助設備市場包括藥品、設備、專門床上用品和醫療保健服務,預計達到800多億美元,未來五年將攀升至1140億美元。

研究公司BCC預測的增長率與之類似。現在,BCC的生命科學內容主管蒂姆·奧布萊恩表示,該行業“突然躥升”。

行業之所以發展迅速,不僅因為消費者強烈渴望優質睡眠帶來的健康,還有一系列新療法和技術,從睡眠藥物到植入式醫療設備再到智能枕頭,都有利于實現目標。

“現在人們對睡個好覺的關注度與其他健康問題差不多。”谷歌(Google)的Nest智能設備線負責人阿什頓·烏達爾說。“人們都希望獲得幫助。”

大腦干涸

睡眠不好會讓人感覺糟糕,反應也不那么敏銳,這已不是新聞。研究表明,睡眠不足導致13%的工人受傷,由于缺勤和效率降低,平均每位員工導致企業損失3500美元。進入新時區第二天,交通事故上升了10%。

然而,長期缺乏睡眠的人并不少。據估計,入睡或持續睡眠有困難的成年美國人百分比在50%到75%之間,連美國疾病預防控制中心(CDC)都將睡眠不足列為公共流行病。蘭德公司(Rand Corporation)的一份報告估計,由于很多人晚上無法規律睡眠至少6小時,每年給美國經濟造成的損失高達2250億美元,其他機構的研究稱損失高達4100億美元。

針對有些頭條新聞宣稱睡眠過多對健康存在危害的說法,睡眠專家表示不必理會。是潛在的健康問題導致個人需要睡眠的時間達8小時以上,而非睡眠過多導致健康問題。

研究人員提供了一系列新觀點,有助于了解睡眠時間不足或睡眠深度不足的影響。研究表明,睡眠不足會嚴重破壞身體新陳代謝,導致疲勞、體重增加和其他問題。

位于波士頓的布列根和婦女醫院(Brigham and Women’s Hospital)的研究員和醫生、哈佛醫學院睡眠醫學部(Harvard Medical School’s Sleep Medicine Division)的主任查爾斯·澤斯勒稱:“睡眠充足時,不僅心情好,對傷害和疾病的抵抗力也更強,甚至有越來越多的證據表明還能提升在其他人眼中的吸引力。澤斯勒還補充道,越來越多的證據甚至讓軍方重新考慮,是否應該繼續用睡眠剝奪當成強化部隊訓練的手段。

根據行業研究公司PatSnap的數據,過去五年中每年關于睡眠和睡眠障礙的科學期刊文章數量大約翻了一番,2020年達到3000篇。

正因為睡眠對大腦衰老造成長期影響的發現,不僅讓睡眠研究者們議論紛紛,也讓消費者拼命尋找提升睡眠的解決方案。

眾所周知,阿爾茨海默癥患者往往睡眠不好。但數十年,來科學家認為睡眠問題只是該病的癥狀,并沒有將其當成可能的病因或催化劑。

2009年,米蘭達·林和同事們發現,經過基因改造的老鼠患上阿爾茨海默癥之類的疾病后,如果睡眠不足會更快出現該病標志性的腦斑塊。“我們發現,睡眠時斑塊消除非常活躍,而白天不活躍。”她說。

那么,相關發現適用人類嗎?這一關鍵問題一直沒有答案,直到今年兩項大型流行病學研究表明,中年睡眠是否充足,是預測幾十年后是否會患上阿爾茨海默癥和其他癡呆癥的可靠因素。

其中一項連續25年的研究從50歲開始追蹤約8000名英國人,發現每晚睡眠時間不超過6小時的人之后患癡呆癥的風險要高出30%。

《自然》雜志(Nature)4月發表論文的主要作者、巴黎法國國家健康與醫學研究院(Inserm)和倫敦大學學院(University College London)研究睡眠的塞維林·薩比亞指出:“現在我們認為,早年建立良好的睡眠習慣有助于降低患病風險,這點非常重要。我們甚至可以利用睡眠干預,延緩阿茲海默癥病人的病情。”

另一項研究發表在2月的《老齡化》雜志(Aging)上,項目跟蹤了3000名65歲及以上的老人五年,發現平均每晚睡眠時間不到5小時的人患癡呆癥的風險達到睡眠正常者的兩倍。

“過去我們不知道如何降低風險,但現在科學表明改善睡眠可能有效。”布列根和婦女醫院的睡眠科學家、哈佛醫學院講師,也是該研究的主要作者麗貝卡·羅賓斯說。同為該研究作者之一的澤斯勒指出,參與者當中睡眠不良者在研究期間死亡的可能性是睡眠正常者的四倍,動脈硬化發病率是正常者的三倍。

與此同時,米蘭達·林正在努力收集證據,證明在失眠小鼠身上發現的斑塊加速積聚可能也發生在人類身上,如果這一點被證實將會成為確鑿證據。

如果能找到有效的方法減少老年癡呆癥的潛在影響,意義將無比重大。55歲以上的人群有八分之一最終患上阿爾茨海默癥或其他癡呆癥,僅在美國每年就要花費6550億美元的醫療費和其他費用。最近僅有一款治療阿爾茨海默癥的藥通過了美國食品與藥品管理局(Food and Drug Administration)批準,引起了爭議。專家們普遍認為,只有少數患者能享受很小的幫助,代價卻十分巨大。如果公眾意識到中年時保持優質睡眠很可能可以有效避免患病,或將瘋狂注重休息。

藥、泵和脈搏

睡眠行業已蓄勢待發。

很多睡不安穩的人第一反應是和近1000萬美國人一樣,靠處方藥獲得更健康的睡眠,他們每年在處方藥上的總花費超過40億美元。市場上四分之一是安定之類苯二氮卓類藥物,這是一種鎮靜劑,也可以緩解焦慮。

其余大部分是業界所謂的“Z-藥物”,例如唑吡坦(安必恩)、佐匹克隆、扎來普隆和艾司佐匹克隆(舒樂安定),都可以增強促進睡眠的神經遞質GABA,誘導睡眠的副作用通常比其他藥少。

但是,目前研究并沒有對任何現有的安眠藥的長期益處給予肯定。5月發表在《英國醫學雜志》(BMJ)開放版上的一項研究發現,經常服用安眠藥的人在兩年后的睡眠時間并不會比不服藥的人群長。

羅賓斯和同事的一項研究更令人不安,該研究似乎顯示服用安眠藥會加大以后患癡呆癥的風險。羅賓斯指出,該聯系可能與導致測試者因睡眠困難而服藥有關,與安眠藥本身關系不大,不過研究也說明目前人們普遍服用的安眠藥,并不是降低癡呆風險的正確選擇。

“可以說,當前的安眠藥可能會幫助睡眠,但無法獲得自然睡眠的好處。”她說。

研究人員和制藥公司忙于研發新藥,正是因為他們清楚地意識到如果有藥能夠提供自然睡眠的體驗,可能會非常暢銷。東京制藥公司衛材(Eisai)去年推出了Dayvigo,通過阻斷某些幫助人保持清醒的神經遞質從而發揮作用。

“我們找到了最新的作用機制。”衛材負責神經病學業務的神經科學家瑪格麗特·莫林說。“我們正在研究其他可能有效實現目標的神經遞質。”但到目前為止,并沒有證據表明其效果更接近自然睡眠。

特別令人感興趣的是研究如何定位大腦中專門控制深度睡眠階段的回路,這似乎對大腦健康益處最大。麻省大學醫學院(University of Massachusetts Medical School)睡眠科學家克里斯泰勒·阿納克萊及其同事開創的研究表明,刺激小鼠大腦某個稱為面神經旁核(parafacial zone)的區域后,根據老鼠腦電波觀察自然深度睡眠長達6小時,比正常單次睡眠時間長20倍。

阿納克萊說:“我們認為很有可能取得進展,找到刺激人腦類似區域的藥。”她補充說,實驗室也在研究是否老鼠睡眠越深對阿爾茨海默癥抵抗力更強。

與此同時,盡管實際研究并未顯示相關產品對睡眠長期益處多大,仍有很多美國人利用大麻產品促進睡眠。

根據大麻市場研究公司Brightfield Group的數據,72%的大麻服用者報告說“睡前”會來一口,近5000萬嘗試過大麻二酚(CBD)的美國人中,主要目的都是提升睡眠質量。

“過去兩年中,我們確實看到人們對睡眠的興趣上升。”位于丹佛的Balanced Health Botanicals公司的首席增長官克里斯·范·杜森說,該公司在業內相當知名,是CBDistillery的子公司。

范·杜森指出,該公司產品是廣受歡迎的非處方睡眠輔助劑,含有大麻二酚和褪黑素的軟糖,銷量非常好。他補充說,公司馬上要推出一款新產品,將大麻二酚與CBN(另一種非精神病性大麻化合物)結合的軟糖,盡管目前沒有太多用以作為支撐的證據,但據說也能助眠。

另一個巨大的睡眠輔助市場則與睡眠呼吸暫停有關。睡眠呼吸暫停是一種疾病,由于睡眠過程中氣道狹窄或神經信號出現錯誤,患者容易喘不過氣,很難睡安穩。美國約有700萬人被診斷患有呼吸暫停,美國睡眠醫學學會(American Academy of Sleep Medicine)估計患者還有2300萬人,這些人要么自己沒有意識到,要么選擇忽視。

澤斯勒說真正的數字可能更高,他表示未接受充分治療的呼吸暫停患者是受到睡眠健康問題影響最嚴重的人群之一。澤斯勒和同事研究發現,呼吸暫停患者比正常人群出現認知障礙跡象平均早10年,出現阿爾茨海默癥跡象早5年,過早死亡的可能性是正常人的6倍。

“研究人員終于開始敲響警鐘。”他說。

呼吸暫停的主要療法是所謂的CPAP機或類似設備,利用大小合適、半剛性的面罩將空氣泵入患病的肺部。機器價格約為500美元起,由于制造商增加了從定制面罩配件到自動調節雙向氣流到無線采集數據等各種功能,很多機器的起價已經高達3000美元甚至更多。據BCC估計,該機器總體來說已在全球形成近40億美元的市場,美國約有500萬的CPAP用戶。

但當被醫生告知使用CPAP機時,通常約40%的患者會因為預期或實際的不適和麻煩,要么拒絕,要么停止使用。小部分不愿意使用CPAP的患者選擇接受手術,切除口腔后部和喉嚨頂部的組織,但存在并發癥和痛苦恢復的風險,而且緩解癥狀的成功率僅為25%左右。

較新的替代方法是“神經調節”,是門診即可完成的小手術。為患者植入微小的裝置和電線后,夜間感知呼吸并向舌頭發送電脈沖,幫助舌頭彎曲并打開氣道。總部位于明尼阿波利斯郊外的Inspire Medical Systems公司提供了美國食品藥品監督管理局(FDA)批準的唯一一種設備,研究顯示使用該設備的一萬多名患者睡眠呼吸暫停問題減少了79%。

如今,總部位于倫敦的LivaNova已經推出臨床版本。該公司的呼吸暫停相關業務負責人約翰·韋伯認為,睡眠問題的壞消息能夠提升人們對該技術的興趣。“預計公眾認知會出現明顯的高峰。”他說。

追蹤睡眠

對于沒有呼吸暫停癥狀以及希望避免用藥的患者,也有越來越多的產品供他們選擇。

比如200美元的ZelEMA智能枕頭,公司聲稱它能夠人工智能檢測打鼾并學習睡眠模式,自動升高或降低枕頭高度,從而調節氣道優化睡眠。售價70美元的Zeeq枕頭不會改變形狀,但聽到打鼾聲后將振動,或許可以打斷粗重的呼吸。枕頭還能夠播放音樂,控制電燈之類智能家電。

目前“智能睡眠面罩”Luuna在Kickstarter上預購價199美元,可以監測睡眠者大腦的電活動,播放“幾乎由自己腦電波組成”的音樂。

一些“光治療”盒或眼鏡能夠理順晝夜節律,短時間讓眼睛看到明亮的藍光或綠光,從而調節身體內部的定時信號,確保晚間感到困倦。與此同時,喜歡冒險的購物者可以通過Gearbest(向美國銷售和發貨的中國大型在線零售商),嘗試一系列更具異國情調的睡眠小工具。

還有一些設備宣稱能夠向鼻孔發射電能和激光,或利用磁力膨脹鼻孔來改善睡眠。

與安眠藥一樣,相關產品都未得到主流睡眠專家的認可。Inserm的薩比亞指出:“到目前為止,沒有明確證據證明產品的效用。” 另一方面,不管鼻腔激光和磁力如何,似乎也沒人把他們明確劃線。

研究發現不管是從仰睡改為側睡,伴著與深度睡眠腦電波同步的聲音入睡,還是一天當中在特定時間照特定光線,都對睡眠和大腦健康有益,其中的光線療法正是俄勒岡健康科學大學的米蘭達·林對睡眠缺乏患者采取的方式。不過大部分療法的效果尚無定論。

另一方面,針對呼吸暫停以外的睡眠問題,專家幾乎一致推薦一種方法:定期早睡,而且環境要放松。澤斯勒指出:“沒有什么比充足睡眠更重要。”他補充說,睡前一小時左右,最好身處安靜黑暗的房間,想些輕松的事情,保持輕度活動,多數人都會發現失眠有所改善。

美國睡眠醫學學會建議,如果有人需要基本睡眠方法以外的幫助,最好咨詢醫學專家、睡眠培訓師或其他可以提供四到八節“失眠認知行為療法”課程(CBT-I)的從業者,根據提供的練習和策略進一步實現深度睡眠。

睡眠相關服務行業正蓬勃發展,根據美國睡眠醫學會統計,其成員包括約11000位經認證的睡眠中心和醫療專業人員,這只是提供睡眠相關服務的專業人員和醫生當中的小部分,還有不少只是兼職。

如果去診所里進行全面的睡眠檢查,技術人員利用設備監測患者睡眠情況,有些不使用設備也很容易花費數千美元,不過對于睡眠呼吸暫停采取正式診斷可能很有必要。

事實上,有一款設備已獲得多數專家認可,雖然它并不能夠代替睡眠衛生和CBT-I等行為方法,但受眾可以從中獲得更多益處。這種設備就是睡眠跟蹤器,或者能夠監控用戶睡眠時間和深度的電子設備和應用程序,某些情況下還可以提供改進方法。

羅賓斯指出,2018年的一項研究發現,三分之一的成年人已經在用某種設備跟蹤睡眠,目前應接近一半。“如果對自己的睡眠狀況感到好奇,那么在做睡眠檢測之前都應該先試一下。”她說。

最流行的睡眠跟蹤器都是可穿戴設備,如手表或腕帶。市場研究公司IndustryARC估計,目前全球可穿戴睡眠跟蹤器市場價值達30億美元,PatSnap估計未來四年睡眠技術市場年增長率為16%。可穿戴式跟蹤器通常利用光學傳感器監測心率,用加速計監測身體活動,利用相關信息不僅能夠推斷睡眠時間長短,還可以推斷出深度睡眠時間。1月谷歌收購的可穿戴設備制造商Fitbit里負責睡眠研究的科學家康納·赫尼根說,該技術在識別睡眠階段方面的準確率約為70%。赫尼根指出,相比之下,權威標準睡眠實驗室EEG數據的準確率約為95%,該數據通過嵌入電路的頭盔來測量腦電波。

Fitbit的companion應用程序為提升睡眠質量,推薦了一系列建議和鍛煉方式,其中很多包月價格僅為9.99美元,具體內容包括睡眠“打分”,可詳細分析不同類型的睡眠、對何時睡覺和何時起床提供建議、深呼吸和正念鍛煉等。

“有充分證據顯示,相關功能對睡眠確實會有積極的影響。”赫尼根說。他補充說,Fitbit早期的一項研究表明,如果遵照建議,平均每晚能夠多睡15分鐘。他指出,公司正計劃增加打鼾檢測功能,如果可以獲得美國食品與藥品管理局批準,今后也能夠增加睡眠呼吸暫停監測。

蘋果公司(Apple)也在Apple Watch的應用程序中提供睡眠支持功能,包括自定義設置“放松”睡眠程序。可穿戴設備制造商Whoop提供每月30美元的服務,可以根據鍛煉、屏幕使用時間、酒精和咖啡因消耗情況,對增加或減少睡眠時間提供建議。美國海軍的拆彈專家就在試用Whoop,說起工作壓力估計沒有人比得上拆彈專家了,最后發現在設備幫助下平均每晚增加了45分鐘睡眠時間。

除了Fitbit部門外,谷歌也在最新版本的智能帶屏幕音箱“Nest Hub”上添加大量睡眠跟蹤和改善功能,從而大力進軍市場。谷歌的烏達爾說,公司驚訝地發現五分之一的音箱都放在臥室里,所以提出了這一想法。

與此同時,用戶調查表明不少人忽視睡眠跟蹤的主要原因是睡覺戴著可穿戴設備不舒服,有些干脆忘了戴。為了避免用戶不適,新款音箱利用麥克風和雷達從床邊無接觸監測身邊睡眠者的情況,包括胸部的起伏。“有沒有打鼾?是不是踢腿了?周圍環境有什么狀況?”他說。“早上會提供詳細信息,不用主動想著。”他補充說,最終信息是關于睡眠持續時間和質量報告,分為八個部分。

研究可穿戴設備市場的Forrester Research的首席分析師朱莉·阿斯克稱,種種新設備都在吸引消費者,但不要對這些設備期望過高。“技術是能夠幫助改進,到最后人們還是得養成健康的習慣。”她說。“對于努力改進睡眠質量的人們而言,健康的生活習慣最能加速實現目標。”

衛材的莫林表示,有時設備造成的問題比解決的問題多。她說:“如果應用程序告訴你睡得不好,反而可能導致情緒沮喪。”她還指出,醫學上將這種為獲得充足睡眠反而導致壓力過大、失眠更加嚴重的新型睡眠障礙稱之為“orthosomnia”,而智能設備就誘發了更多相關病例。另一方面,睡眠醫生會鼓勵因感到壓力而想辦法改善睡眠。(財富中文網)

譯者:馮豐

審校:夏林

Last year Miranda Lim found that taking care of three young children homebound by the pandemic meant she often had to work late into the evening to stay on top of her job. Concerned that the extended hours were taking a toll on her sleep, Lim started tracking her sleep time with an app on her iPhone. She wasn’t quite prepared for the results. “I saw my bedtime was bouncing anywhere between 9 p.m. and 3 a.m.,” she says. “I was just horrified.” As a result, she immediately set up a daily alarm—not for waking up, but for heading off to bed at a reasonable hour.

It’s understandable why Lim would be a bit of an alarmist, so to speak, when threatened with a lack of a consistent night’s sleep. A neurologist at the Oregon Health & Science University and a sleep disorders physician at the VA Portland Health Care System, Lim is at the forefront of a global cadre of medical researchers who have in recent years been pinning down the ways in which even moderate sleep deficiencies in middle age strongly link to Alzheimer’s disease and dementia later in life. “We used to think that sleep problems were just another symptom of Alzheimer’s,” she says. “Our big discovery was that the lack of sleep involves brain processes that may develop into the disease.”

The finding that getting more and better sleep could offer the best, and possibly only, way to significantly reduce the risks of neurodegeneration in older age—along with new insights into a range of other health benefits—is likely to further fuel an already hot sleep industry. Market research firm Infinium Global Research puts the current worldwide market for sleep aids—including drugs, devices, special bedding, and health care services—at an estimated $80 billion–plus, and predicts it will climb to $114 billion over the next five years. Research firm BCC has been projecting a similar growth rate. But these estimates were calculated before the new links to long-term neurodegeneration hit the journals. Now Tim O’Brien, who heads life sciences content at BCC, says he’s watching for “a sudden leap.”

That leap would be driven not only by consumers’ intensifying pursuit of better sleep-related health, but also by a stream of new therapies and technologies that are emerging to help achieve it, from sleep drugs to implantable medical devices to smart pillows. “Concerns about getting a good night’s sleep are now on the same level as concerns about other major health disorders,” says Ashton Udall, who heads up Google’s Nest smart-device line, some of which is getting a range of sleep-related features. “People are looking for help.”

Brain drain

It’s not exactly news that sleeping poorly makes us feel lousy and less sharp. Studies have shown that a shortage of sleep causes 13% of injuries to workers and costs companies $3,500 per affected employee in absenteeism and reduced productivity. Car accidents climb by 10% on the day after a time-zone change. The chronically sleep-deprived are not a rare breed: Estimates of the percentage of adult Americans who regularly have trouble falling or staying asleep range from 50% to 75%, leading the CDC to label sleep deficiency a public-health epidemic. A Rand Corporation report reckons the widespread inability to regularly get at least six hours of sleep costs the U.S. economy $225 billion a year, and other studies have put the costs as high as $410 billion. (Those headlines about the health risks of sleeping too much? Ignore them, say sleep experts. The regular need for more than about eight hours of sleep is usually caused by an underlying health problem, not vice versa.)

Researchers are uncovering a bevy of new insights into just how far-reaching the impact of not sleeping enough hours—or not sleeping deeply enough—can be. Studies have shown that sleep deficiency can wreak havoc with the body’s metabolism, leading to fatigue, weight gain, and other problems. “When you get enough sleep you’ll not only feel better, be in a better mood, and be more resilient to injury and disease, there’s even increasing evidence other people will find you more attractive,” says Charles Czeisler, a researcher and physician at Boston’s Brigham and Women’s Hospital and director of the Harvard Medical School’s Sleep Medicine Division. Czeisler adds that the mounting evidence even has the military rethinking its reliance on sleep deprivation as a means of toughening troops up in training. The number of scientific journal articles about sleep and sleep disorders published annually has roughly doubled in the past five years, hitting 3,000 articles in 2020, according to industry research firm PatSnap.

But it’s the discovery of the apparent long-term impact of sleep on the aging brain that has sleep researchers buzzing—and that promises to send consumers scrambling for sleep-boosting solutions. It has been known for decades that people with Alzheimer’s tend to sleep poorly, but scientists saw sleep trouble as a symptom, not a possible cause or accelerant, of the disease. Then in 2009 Lim and colleagues showed that mice genetically engineered to suffer an Alzheimer’s-like disease formed the disorder’s signature brain plaque much more quickly when they were deprived of sleep. “We showed the process of removing plaque is very active during sleep, and not active during the day,” says Lim.

But did the findings apply to humans? That critical question remained open until this year, when two large epidemiological studies came out to show that lack of sleep in middle age was a strong predictor of Alzheimer’s and other forms of dementia decades later. One of the studies tracked some 8,000 people in Britain for 25 years starting at age 50, finding that those who slept six hours or less a night had a 30% greater risk of developing dementia later. “Now we think it’s important to establish good sleep habits in earlier adulthood to help reduce the risk,” says Séverine Sabia, who researches sleep at Inserm in Paris and University College London, and was lead author of that study, published in April in Nature. “We may even be able to use sleep interventions to delay the progress of the disease for someone already on the path to Alzheimer’s.”

The other study, published in February in the journal Aging, followed just under 3,000 people age 65 and older for five years, finding that those who didn’t get at least five hours of sleep per night on average had twice the risk of dementia. “We used to think there was little we knew to do to reduce the risk, but now the science suggests that improving sleep might work,” says Rebecca Robbins, a sleep scientist at Brigham and Women’s Hospital and a Harvard Medical School instructor, and lead author of the study. Czeisler, also an author of the study, notes that the poor-sleeper participants were up to four times as likely to die during the study, and had triple the rate of hardening arteries. Lim, meanwhile, is now trying to gather evidence that the accelerated plaque accumulation she found in sleepless mice similarly occurs in humans, which would represent a smoking gun.

It’s hard to overemphasize the potential impact of the discovery of an effective approach to curtailing Alzheimer’s. One out of eight people who live beyond age 55 eventually develops Alzheimer’s or another form of dementia, leading to $655 billion a year in medical and other costs in the U.S. alone. There’s only one drug approved—recently and controversially—by the Food and Drug Administration to treat Alzheimer’s, and it’s widely expected by experts to be of only small benefit to only a small minority of patients, at enormous cost. As the public catches on to the fact that better sleep in middle age may well provide a heavy dose of protection, the quest for rest could reach a frenzy.

Pills, pumps, and pulses

The sleep industry is ready to oblige. For many of the restless, the first reaction will be to join the nearly 10 million Americans who take prescription pills to try to get more or sounder sleep, spending more than $4 billion a year on them. A quarter of that market is for benzodiazepines like Valium, which are tranquilizers that can also ease anxiety. Most of the rest is for what the industry calls “Z-drugs”—zolpidem (Ambien), zopiclone, zaleplon, and eszopiclone (Lunesta)—which amplify the sleep-promoting neurotransmitter GABA, often inducing sleep with fewer side effects than other drugs.

But research hasn’t been encouraging about the long-term benefits of any currently available sleeping pills. A study published in May in BMJ Open found that after two years those who regularly took pills didn’t report getting more sleep than a similar group that went pill-less. More troubling was a study conducted by Robbins and colleagues that seemed to show taking pills was linked to an increased risk of later dementia. That association may have more to do with the sleep challenges that drive subjects to take pills in the first place rather than the pills themselves, notes Robbins, but it does suggest that the pills commonly taken today aren’t the right approach to lowering dementia risk. “They may help get you down, so to speak, but you won’t get the wonderful benefits of natural sleep,” she says.

Well aware that a pill providing a more natural sleep experience would likely be an explosive blockbuster, researchers and pharmaceutical companies are busy trying to come up with drugs that come closer to that goal. Tokyo-based pharma Eisai last year introduced Dayvigo, a drug that works by blocking the action of certain neurotransmitters that promote wakefulness. “We’ve got the latest mechanism of action,” says Margaret Moline, a neuroscientist who heads Eisai’s neurology business. “And we’re looking at other neurotransmitters that might be good targets.” But so far there’s little evidence the results are closer to natural sleep.

Particularly intriguing is research into ways of targeting the circuits in the brain that appear to specifically control the deeper sleep stages that seem linked to the greatest brain-health benefits. Work pioneered by University of Massachusetts Medical School sleep scientist Christelle Anaclet and colleagues has shown that stimulating a region of the mouse brain called the parafacial zone can keep mice in what their brain waves indicate is natural deep sleep for as long as six hours—some 20 times as long as they normally sleep at one shot. “We think there’s a good chance we can make progress in finding a drug that stimulates a similar brain region in people,” says Anaclet. She adds that her lab is also looking at whether the deeper-sleeping mice are more resistant to Alzheimer’s-like disease.

In the meantime, many Americans are turning to cannabis products to boost sleep, in spite of the fact that studies haven’t found much long-term benefit to them along those lines. According to cannabis market research firm Brightfield Group, 72% of cannabis users report getting high “right before bed,” and among the nearly 50 million Americans who have tried CBD, better sleep was the No. 1 reason. “We’ve really seen sleep interest take off in the past two years,” says Chris Van Dusen, chief growth officer at Balanced Health Botanicals, whose Denver-based CBDistillery subsidiary is a well-established brand. The company offers a gummy containing a mix of CBD and melatonin—a popular over-the-counter sleep aid—and it’s a bestseller, Van Dusen says. He adds that a new up-and-comer for the company is a gummy that combines CBD with CBN, another nonpsychoactive cannabis compound claimed by many, albeit without much evidence, to promote sleep.

Another huge sleep-aid market is the one tied to sleep apnea, a disorder in which narrowing airways or faulty nerve signals during sleep can leave sufferers gasping for air, making sound sleep all but impossible. About 7 million people in the U.S. are diagnosed with apnea, but the American Academy of Sleep Medicine estimates another 23 million have it but either don’t know it or ignore it. The true number is likely even higher, says Czeisler, noting that those with undertreated apnea are among the hardest hit by long-term health problems related to sleep deficiency. Studies by Czeisler and colleagues have found apnea sufferers show signs of cognitive impairment 10 years earlier than others on average, and of Alzheimer’s five years earlier, while being six times as likely to die prematurely. “Researchers have finally started ringing the alarm bells about this,” he says.

The main treatment for apnea is a so-called CPAP machine or similar device capable of pushing air into the lungs of an afflicted sleeper by pumping it through a fitted, semirigid face mask. These machines start at about $500, but many now run to $3,000 and more as manufacturers add in everything from custom mask-fitting to auto-adjusting two-way airflow to wireless connectivity for data collection. All told it’s already a nearly $4 billion market globally, estimates BCC, with some 5 million CPAP users in the U.S.

But about 40% of patients told by a doctor to use a CPAP machine either refuse, or stop using it, usually because of anticipated or actual discomfort and bother. A small percentage of CPAP refuseniks elect instead to have tissue surgically removed from the back of their mouths and top of their throats, a procedure that carries a risk of complications and painful recovery, yet has only about a 25% success rate in mitigating the problem. A newer alternative is “neuromodulation,” which involves minor outpatient surgery to implant a tiny device and wire that senses breathing at night and sends an electrical pulse to the tongue to get it to flex and open up the airway. Inspire Medical Systems, headquartered just outside Minneapolis, offers the only FDA-approved device, with studies showing a 79% reduction in sleep apnea problems for the more than 10,000 patients who have received it. Now London-based LivaNova has a version in clinical trials. John Webb, who heads up the company’s apnea-related business, thinks the stream of bad news about sleep problems will drive interest in the technology. “We’re anticipating a definite spike in awareness,” he says.

Hit the sack—and track

For those poor sleepers who don’t have apnea and who prefer to avoid the drug route, a growing array of products beckons. Consider the $200 Zerema smart pillow, which the company claims enlists artificial intelligence to detect snoring and learn sleep patterns in order to automatically raise or lower the height of the pillow so as to adjust airways and optimize sleep. The $70 Zeeq pillow doesn’t change shape, but it does listen for snoring and vibrate in response, presumably as a means of interrupting the noisy breathing. It also streams music and controls smart-home appliances like lights. The Luuna “intelligent sleep mask”, currently available for preorder at $199 on Kickstarter, promises to monitor electrical activity in the sleeper’s brain and play music that is “pretty much composed by your brain waves.” And any number of “light-therapy” boxes or glasses offer to straighten out your circadian rhythm—the body’s internal timing signal that tends to sync sleepiness with nighttime—by briefly exposing the eyes to bright blue or green light in the morning. Adventurous shoppers, meanwhile, can explore a trove of more exotic sleep gadgets via Gearbest, the giant Chinese online retailer that sells and ships to the U.S. Among the finds there are devices that promise to improve sleep by beaming electricity and laser light up your nostrils, or magnetically dilating them.

As with pills, none of these products get ringing endorsements from leading sleep experts. “There’s no clear evidence so far on their usefulness,” notes Inserm’s Sabia. On the other hand, nasal lasers and magnets aside, no one seems ready to rule them out, either. In fact, studies have found sleep and brain-health benefits to getting troubled sleepers off their backs and onto their sides, to piping in sounds that are in sync with deep-sleep brain waves, and to exposing people to various types of light at certain times of day—an approach that Lim of Oregon Health & Science University is studying with sleep-deficient patients. But the verdict is still out on most of these gizmos.

On the other hand, experts are virtually unanimous in recommending one particular approach for tackling non–apnea-related sleep problems: Regularly get to bed earlier, and in a more relaxing environment. “There’s no substitute for giving yourself the time you need to sleep,” says Czeisler. Throw in a quiet, dark room and some soothing thoughts and low-key activities in the hour or so leading up to bedtime, he adds, and most people will find their insomnia improves.

The American Academy of Sleep Medicine advises those who need help beyond this basic “sleep-hygiene” approach to consult a therapist, sleep coach, or other practitioner who can provide a four- to eight-session course of “cognitive behavioral therapy for insomnia,” or CBT-I, which offers other exercises and strategies to further ease the path to deep sleep. The sleep-related services industry itself is a thriving one, with the AASM counting some 11,000 accredited sleep centers and health care professionals among its members—and that would represent only a fraction of the professionals and practices that offer sleep-related services at least as a sideline. A full sleep study at a clinic, where technicians monitor a wired-up patient’s sleep, or lack thereof, can easily run to several thousands of dollars, but may be necessary for a formal diagnosis of sleep apnea.

There is, in fact, one type of gadget that most experts are endorsing—not instead of behavioral approaches like sleep hygiene and CBT-I, but as a way of getting more out of them. That’s sleep trackers, or electronic devices and apps that can monitor how long and deeply users are sleeping, and in some cases point out ways to make improvements. Robbins notes that a 2018 study found that a third of adults were already tracking their sleep with some sort of device, and estimates it’s closer to half now. “Anyone curious about how well they’re sleeping should try one as a first step, before going to get a sleep study,” she says.

The most popular sleep trackers are wearables, usually as watches or wristbands. Market research firm IndustryARC puts the current wearable sleep tracker worldwide market at $3 billion, and PatSnap estimates a 16% annual growth rate for the sleep technology market over the next four years. Wearable trackers typically measure heart rate through optical sensors, and body movement with accelerometers, using the information to infer not only length of sleep time but also how much of the time was spent in deeper stages of sleep. The technique is about 70% accurate in identifying sleep stages, says Conor Heneghan, a scientist who heads sleep research for Fitbit, the wearable manufacturer bought by Google in January. Heneghan notes that compares to about 95% accuracy from a gold-standard sleep-lab EEG reading, which measures electrical activity in the brain through an electrode-studded skullcap.

Fitbit’s companion app offers a range of insights and exercises aimed at boosting sleep—many available with an only $9.99 per month premium subscription—including sleep “scores” that break down different aspects of sleep, recommendations for when to get to bed and when to wake up, deep breathing and mindfulness exercises, and more. “There’s good evidence that these supports do have a positive impact on sleep,” says Heneghan, adding that an earlier Fitbit study suggested the efforts averaged an additional 15 minutes of sleep per night. He says the company is planning on adding in snoring detection, and may down the road be able to identify sleep apnea problems, perhaps even with FDA approval.

Apple, too, provides sleep-support features in its Apple Watch apps, including the ability to set up a custom “wind down” bedtime routine. And wearable maker Whoop offers a $30 per month service that can recommend when you need more or less sleep based on your workouts, screen time, and alcohol and caffeine consumption. The U.S. Navy tested Whoop on its bomb-defusing specialists—talk about stressful jobs—and determined the support added an average of 45 minutes of sleep per night.

Aside from its Fitbit unit, Google is making a big push into the market by packing a number of sleep-tracking and -promoting features into the latest version of its “Nest Hub” smart speaker-and-screen device. Google’s Udall says the idea for doing so came when the company was surprised to discover that about one out of five Hubs was ending up in the bedroom. Meanwhile, its user surveys indicated the main reason people neglected to stay with sleep-tracking was finding wearables uncomfortable at night, or simply forgetting to put them on. To avoid that friction, the new Hub uses microphone and radar to contactlessly track from bedside what’s happening with the nearest sleeper, including the rising and falling of the chest. “Is there snoring? Are legs kicking? What’s happening in the surrounding environment?” he says. “We have the details waiting for you in the morning, without you having to think about it.” The information is presented in an eight-point report about sleep duration and quality, he adds.

These sorts of gadgets are catching on with consumers, says Julie Ask, principal analyst with Forrester Research, who studies the wearables market. But don’t expect too much from the devices, she adds. “The tech can help with nudges, but people still have to develop the healthy habits,” she says. “It’s best at accelerating good outcomes for those who are already committed to doing that.”

In fact, the gadgets can sometimes cause more problems than they solve, says Eisai’s Moline. “When an app is telling you you’re not sleeping well, it can cause distress,” she says, noting that there’s a medical term for excessive stress about getting enough sleep—orthosomnia—and that smart devices are spurring more cases. On the other hand, a little stress about rest may be just what the sleep doctor ordered, if it leads to a solution that smooths the snooze.

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