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褪黑素不是安眠药,如何正确使用它?

Melatonin Isn’t a Sleeping Pill. Here’s How to Use It.
褪黑素不是安眠药,如何正确使用它?

Most people think of melatonin as a natural nod-off aid, kind of like chamomile tea in pill form. Even the name of the popular dietary supplement sounds sleepy — that long “o” sound almost makes you yawn mid-word. But melatonin is also a hormone that our brains naturally produce, and hormones, even in minuscule amounts, can have potent effects throughout the body.

大多数人都认为褪黑素就是一种天然助眠剂,就好比做成了药片的甘菊茶。这种流行膳食补充剂连名字都听起来让人犯困——长长的“o”音几乎让人在说到一半的时候就想打哈欠。但褪黑素也是我们大脑自然产生的一种激素,只要是激素,哪怕极少量,也可能会对人体产生巨大的影响。

“There are some clinical uses for it, but not the way that it’s marketed and used by the vast majority of the general public,” said Jennifer Martin, a psychologist and professor of medicine at the University of California, Los Angeles.

“褪黑素是有一些临床用途,但那跟营销里说的,以及绝大多数公众的用法不一样,”加州大学洛杉矶分校的心理学家、医学教授詹妮弗·马丁表示。
 

Experts strongly urge people to consult their doctor or a sleep specialist before taking melatonin, in part because the supplement does not address many underlying health problems that may be disrupting sleep. Anxiety can cause insomnia, as can a host of other potentially serious ailments, such as sleep apnea, restless legs syndrome or mood disorders like depression, that may require medical treatment.

专家强烈建议在服用褪黑素之前咨询自己的医生或睡眠专家,部分原因是这种补充剂不能解决很多可能影响睡眠的潜在健康问题。焦虑和其他许多可能变得非常严重的疾病都会导致失眠,包括睡眠呼吸中止症、不宁腿综合征或抑郁症等情绪障碍,而这些问题可能都需要就医。

Melatonin, however, is relatively inexpensive and readily available at local pharmacies in the United States (in other countries it typically requires a prescription), and many people will go out and buy it on their own. So what’s the best approach to taking melatonin? Here’s what experts had to say.

然而,褪黑素价格相对便宜,在美国的地方药店也很容易买到(在有些国家通常需要处方),很多人都能出门自行购买。那么,服用褪黑素的最佳方法是什么?以下是专家们的看法。

How does melatonin work?

褪黑素是如何起作用呢?


During the day, the brain’s pea-sized pineal gland remains inactive. A few hours before our natural sleep time, as it starts to get dark outside and the light entering our retina fades, the gland switches on to flood the brain with melatonin.

白天,人脑中豌豆大小的松果体处于不活跃状态。在自然睡眠时间的前几个小时,天色开始变黑,进入视网膜的光线逐渐减弱,松果体就会开始分泌大量褪黑素。

“Melatonin is sometimes called the ‘hormone of darkness’ or ‘vampire hormone,’” because it comes out at night, said Matthew Walker, a professor of neuroscience and psychology at the University of California, Berkeley, and the author of the book “Why We Sleep.” As levels of melatonin rise, levels of cortisol, the stress hormone, fall. Respiration slows. Soon, our eyelids begin to droop.

因为在夜间出现,“褪黑素有时被称为‘黑暗激素’或‘吸血鬼激素’,”加州大学伯克利分校的神经科学兼心理学教授马修·沃克表示,他是《我们为何要睡觉》一书的作者。随着褪黑素水平的上升,应激激素皮质醇的水平会下降。呼吸放缓。很快,我们的眼皮开始打架。

Instead of a lights-out trigger, melatonin acts more like a dimmer switch, turning the day functions off and switching night functions on. So taking a melatonin supplement is sort of like taking a dose of sunset, tricking your body into feeling like it’s nighttime. It doesn’t put you to sleep as much as it tells the body that it’s time to sleep.

与其说是熄灯按钮,不如说褪黑素更像一个灯光调暗器,关闭了白天功能,打开了夜间功能。因此,服用褪黑素补剂就像是吸收了一点夕阳,帮助你的身体感觉到夜晚。它并不会让你入睡,而是会告诉身体该睡觉了。

“It may take several hours,” said Dr. Ilene M. Rosen, a sleep medicine doctor and associate professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, “which is what I think is the misconception about how melatonin is used.”

“这个过程可能需要几个小时,”宾夕法尼亚大学佩雷尔曼医学院的睡眠医学博士兼医学副教授艾琳·M·罗森表示,“而这在我看来就是公众对于褪黑素使用方式的误解所在。”

Melatonin may make you feel a little drowsier when you take it, but it has a bigger impact on regulating the timing of your overall sleep-wake cycle and helping to set the circadian clock, the roughly 24-hour internal timekeeper that tells your body what time of day it is and syncs it with the outside world.

褪黑素可能会让人在服用后感到一点困倦,但它更大的影响在于调节入睡到醒来的整个周期时间,并帮助设定生物钟,这种大约24小时的体内计时器会告诉身体现在是一天中的什么时间,并与外部世界同步。

“The impact it has on our sleep depends on the time of day that you take it,” said Dr. Martin, who is also a spokeswoman for the American Academy of Sleep Medicine. “If you took a sleeping pill in the middle of the day, it would make you feel sleepy. If you took melatonin in the middle of the day, it doesn’t really have that effect.”

“它对我们睡眠的影响取决于你的服用时间,”同时还是美国睡眠医学会发言人的马丁说。“如果你在中午吃安眠药,你就会感到困倦。如果你在中午吃褪黑素,就不会有这种效果。”

Hypnotic drugs like Ambien or Benadryl generally cause people to feel sleepy right away, and the sedation effect of those medications “far exceeds that which they obtain from melatonin,” said Dr. Alon Y. Avidan, a professor of neurology and director of the Sleep Disorders Center at U.C.L.A.

安必恩或苯那君等催眠药物通常会立刻引发睡意,这些药物的镇静效果“远超过褪黑素”,加州大学洛杉矶分校神经学教授兼睡眠障碍中心主任阿隆·Y·阿维丹博士表示。

How effective is melatonin?

褪黑素的效果如何?


In one analysis published in 2013 in PLOS One, which combined results from 19 studies involving 1,683 men and women, people who took melatonin supplements fell asleep seven minutes faster and increased overall sleep time by eight minutes. That may not sound like much, but there was a lot of individual variation, and researchers found that melatonin also improved overall sleep quality, including people’s ability to wake up feeling refreshed.

在2013年发表在PLOS ONE上的一项分析综合了19项研究的结果,这些研究共有1683名受试男性和女性,服用褪黑激素补充剂的人入睡速度加快了7分钟,整体睡眠时间增加了8分钟。这听起来可能不多,但个体差异很大,研究人员发现褪黑激素还改善了整体睡眠质量,包括人们醒来时是否感觉神清气爽。

But there’s no guarantee that melatonin will work for you.

但不能保证褪黑激素对你有效。

Dr. Sabra Abbott, an assistant professor of neurology in sleep medicine at Northwestern University Feinberg School of Medicine, said the most common complaint she hears from patients is “I tried melatonin and it didn’t work.” Many also feel hung over or groggy the next morning.

西北大学费恩伯格医学院研究睡眠医学的神经学助理教授萨布拉·阿博特说,她从患者那里听到的最常见的抱怨是“我尝试了褪黑激素,但没有用”。第二天早上,许多人还感到难受或昏昏沉沉。

Dr. Martin said that in many studies, melatonin does not work any better than a placebo but added, “One caveat I always like to mention, though, is that placebos work pretty well for insomnia.”

马丁说,在许多研究中,褪黑激素的效果并不比安慰剂好,但他还说,“不过,我经常会提醒别人,安慰剂对失眠症的效果很好。”

What about dosage?

谈谈剂量?


We naturally make melatonin in our brains, but only in picogram amounts, or one trillionth of a gram, which Dr. Rosen described as “a whiff of it coming out at dusk.” Over-the-counter melatonin supplements come in much higher milligram doses, or a thousandth of a gram. That’s a big difference, although the amount that ultimately reaches the brain more closely approximates natural levels.

我们本身会在大脑中制造褪黑激素,但这是按皮克计量的,皮克即万亿分之一克,罗森将其描述为“黄昏时散发出的一丝气息”。非处方褪黑激素补充剂的毫克剂量要高得多,毫克即千分之一克。这是一个很大的差异,尽管最终到达大脑的量更接近自然水平。

Many experts recommend starting with the smallest available dosage — 0.5 milligrams to 1 milligram, 30 minutes to an hour before bedtime — and seeing how you do from there. If that has no effect, the dose can be gradually increased.

许多专家建议从能买到的最小剂量开始——睡前30分钟到一个小时服用0.5毫克到1毫克——然后看看效果如何。如果没有效果,可以逐渐增加剂量。

“If you try a dose, stick to it for a few days before you make an adjustment,” Dr. Martin said. “It’s one of those things that may not happen overnight.”

“如果你尝试了一种剂量,坚持按这种剂量服用几天后再进行调整,”马丁说。“这种改变不会发生在一夜之间。”

“Keep a close eye on how you feel the next day,” Dr. Abbott said. “Feeling groggy or hung over is a sign that the dose is probably too high.”

“密切关注第二天的感受,”阿博特说。“感觉昏昏沉沉或难受表明剂量可能太高了。”

Are there side effects?

有副作用吗?


The good news: In the short term, at least, melatonin is unlikely to do any harm.

好消息:至少在短期内,褪黑激素不太可能造成任何伤害。

“Compared to most other sleeping pills, the side-effect profile is much better,” and it’s not going to be addictive, said Dr. Bhanu Prakash Kolla, an associate professor of psychiatry and a consultant at the Center for Sleep Medicine at the Mayo Clinic. But because melatonin can cause drowsiness, the Mayo Clinic warns that you shouldn’t drive or operate machinery within five hours of taking it.

精神病学副教授兼妙佑医疗睡眠医学中心顾问巴努·普拉卡什·科拉博士说:“从副作用方面看,它比大多数助眠药物要好得多,”而且它不会成瘾。但由于褪黑激素会导致嗜睡,妙佑医疗警告说,不应在服用后五小时内驾驶或操作机器。

Does melatonin affect our dreams?

褪黑激素会影响我们的梦吗?


“Far and away, the most common side effect that I have patients report to me is that their dreams just become much more vivid,” Dr. Abbott said. Scientists aren’t sure why that happens.

“一直以来,病人报告的最常见的副作用是,他们的梦变得更加生动,”阿博特说。科学家们还不确定为什么会这样。

Dr. Kolla has also seen patients who have nightmares or disruptive dreams, which are also common with sleeping pills. “In that case, you want to try to lower the dose,” he said. “Or, if it’s too problematic, stop.”

科拉还见过一些病人做噩梦或做破坏性的梦,这在服用安眠药时也很常见。“在这种情况下,需要尝试降低剂量,”他说。“或者,如果问题太大,就停下来。”

How do doctors use melatonin?

医生如何使用褪黑素?


Sleep doctors may use melatonin to help patients with circadian rhythm disorders regulate their sleep-wake cycles. For example, during the pandemic, Dr. Avidan said, “we’ve seen those people who become super night owls” unable to fall asleep until 2 or 3 a.m.

睡眠医生可以使用褪黑素来帮助昼夜节律紊乱的患者调节睡眠-醒来周期。例如,阿维丹说,在疫情期间,“我们看到那些成为超级夜猫子的人”直到凌晨两三点才入睡。

Experts also suggest people use a bright light in the mornings to help them wake up, which has “alerting properties and can suppress any remaining melatonin production,” said Dr. Abbott.

阿博特说,专家还建议人们在早上使用强光来帮助自己醒来,强光具有“警示作用,可以抑制剩余的褪黑素的产生”。

Should you take melatonin for jet lag?

你应该服用褪黑素来缓解时差吗?


Jet lag is a circadian rhythm disorder, albeit a temporary one, so melatonin may help. To alleviate the worst effects, doctors recommend consulting one of several online calculators available, which ask you for your destination and arrival points, your flight time and your normal sleep patterns. Two sites that Dr. Avidan recommends are Jet Lag Rooster or the calculator from Fleet Street Clinic.

时差反应是一种昼夜节律紊乱,然而只是暂时的,所以褪黑素可能会有所帮助。为了减轻最坏的影响,医生建议使用现成的在线计算器,它们要求你提供你的目的地和到达地、飞行时间和正常睡眠模式。阿维丹推荐的两个网站是Jet Lag Rooster和舰队街诊所的计算器。

“They’re trying to tell you when to take the melatonin so your body knows: ‘Oh, it’s dusk where I’m going,’” Dr. Rosen said, explaining how you can use the supplement before your trip to readjust your body clock.

罗森解释了如何在出发前服用这种补充剂来调整生物钟:“它们可以告诉你什么时候服用褪黑激素,这样你的身体就知道:‘哦,我要去的地方已经是黄昏了。’”

How do you pick a reliable brand of melatonin?

如何选择可靠的褪黑素品牌?


Like other dietary supplements, melatonin is not regulated by the Food and Drug Administration, which means there may be wide variation among products. A study published in the Journal of Clinical Sleep Medicine found that the content of more than 70 percent of melatonin supplements varied widely from their label claims. The concentration ranged from 83 percent less than the amount listed to 478 percent more.

与其他膳食补充剂一样,褪黑素不受食品和药物管理局的监管,这意味着不同产品之间的差异可能很大。发表在《临床睡眠医学期刊》(Journal of Clinical Sleep Medicine)上的一项研究发现,超过70%的褪黑素补充剂的成分与标签说明差别很大。其浓度最少低于标签所列的83%最多高于标签所列的478%。

Dr. Kolla advised looking for a GLP (good laboratory practice) or GMP (good manufacturing practice) label, which refers to federal regulations designed to affirm a product has the advertised quality and purity. “You really don’t know what you’re getting, so you’re trusting the manufacturer,” he said. Melatonin comes in pills, gummies or liquid; the choice comes down to personal preference, he added.

科拉建议认准GLP(良好实验室规范)或GMP(良好生产规范)标签,后者是指符合旨在确认产品具有广告宣传的质量和纯度的联邦法规。“你真的不知道自己会得到什么,所以得相信制造商,”他说。褪黑素制品包括药片、软糖或液体;他说,如何选择取决于个人喜好。

What are alternatives for chronic insomnia?

还有什么方案可以治疗慢性失眠?


Sleep doctors strongly urge people with chronic insomnia to seek out cognitive behavioral therapy, a short-term psychological treatment that can help get to the root of the problem.

睡眠医生强烈建议患有慢性失眠症的人寻求认知行为疗法,这是一种短期的心理治疗,可以帮助找到问题的根源。

“If you give melatonin to a patient and you don’t complement it with behavioral therapy for insomnia, you may not necessarily see the effects that you’re looking for,” Dr. Avidan said.

“如果你给病人服用褪黑素,而不辅以治疗失眠的行为疗法,你可能不一定能得到想要的效果,”阿维丹说。

Many common behaviors can also make it harder for us to fall — and stay — asleep, including using our phones near bedtime, which can hamper natural melatonin production. Meditation may help, as can warm showers and cool bedrooms, or giving up caffeine and alcohol.

许多常见的行为也会让我们更难入睡和保持睡眠,包括在睡前使用手机,这会阻碍自然褪黑素的产生。冥想可能会有帮助,还有热水淋浴和保持卧室凉爽,或放弃咖啡因及酒精。

“There are a lot of other things people could do to help themselves sleep better,” Dr. Martin said. “They’re just harder.”

“人们可以做很多事来帮助自己睡得更好,”马丁说。“只不过那些事更难做到。”
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