It's hard to sort out, is it because of exposure to carcinogens or is it because of sleep deprivation?
We know that sleep deprivation results in immune system dysfunction, which is probably
why there's this increased risk for cancer.
Welcome to the Firefighter Crascmanship Podcast, where we give you real tools to train ultimate
humor performance both on and off the emergency scene.
I'm your host, Kevin Housley.
Let's get to it.
All right, welcome back to the Firefighter Crascmanship Podcast.
Today, we have a very special guest, Dr. Mark Petron, and we're going to dive into sleep,
the nice fun topic of sleep in relation to shift work.
And we're excited to have Dr. Petron here with us today.
So welcome to the show.
Thank you very much.
It's great having me.
I'm very excited to kind of ask you some of these pressing questions that we have, but
we're going to basically keep it really, really simple.
There's a lot of chatter out there about sleep.
You know, Dr. Matthew Walker wrote a book about why we sleep.
It's just gotten a lot of really good positive press, and it's kind of got some really fun
conversations started in a lot of our organizations, or at least with us personally.
But then that kind of stops as far as sleep.
How do we maybe implement some of this stuff?
How does it apply to us as shift workers?
So I'm excited to kind of talk to you today about that.
So you started your Doctor of Pulmonology, and how did you get involved in the whole
sleep aspect?
Why does a pulmonologist care about sleep?
Yeah, that's an excellent question.
Because primarily the sleep problem that most people have or have knowledge about is obstructive
sleep apnea.
And we, in our training and pulmonary training, we all learn about obstructive sleep apnea.
Me personally, when I was doing my fellowship, we had a sleep lab, which back in the day
was somewhat unusual, and my research project was looking at control of breathing during
sleep, which is different than control of breathing awake.
So that's how I personally got started, but a lot of pulmonary doctors end up going down
to sleep, Rob.
So if we end up doing a sleep study or something like that, are you going to potentially see
a pulmonologist or are you going to see some sort of sleep specialist?
So nowadays, sleep medicine is a specialty, and it's actually a fellowship trained specialty.
So when I was training, it wasn't that way.
So I did a lot of additional courses over the years, and that's how I became trained,
not in a formal fellowship.
But now there's quite a few sleep medicine doctors.
And when people have significant problems with sleep, a lot of times that's the best
place to start is with a sleep specialist.
Fantastic.
Well, it's nice that there's more of them out there now.
So you might actually get an appointment if you want one, right?
For sure.
So when did you start practicing as an MD?
Oh, 1981.
Okay.
So you've been in the game a long time.
You've seen positives and negatives all the way with medicine, and then especially in
the sleep space, no doubt about it, where, like you said, during your fellowship, there
wasn't necessarily like a sleep doctor.
It was more of the pulmonology route.
Sleep medicine has exploded since the 1990s.
I think I got my first sleep medicine certification in 1991 or 1992.
I don't remember exactly.
But that's because there wasn't certifications before then.
Yeah.
Okay.
Fantastic.
So can you kind of describe to us, for those of us that don't know, what is obstructive
sleep apnea?
Yeah.
So obstructive sleep apnea, as most of us think about it, is it's when you're asleep
and you obstruct your airway.
And the level of obstruction of the airway is usually soft palate.
So if you think about it, if you go straight back through your mouth, there's hard palate,
and there's the epiglottis, that thing that hangs down in the back, and that's the part
of the, that's generally the part that is obstructing.
And it's more complicated than that because the musculature that holds our airway open,
when we go to sleep, that tone decreases, the tone in the airway.
It's kind of like the tone in our skeletal muscles too, but the tone in the airway decreases
and that's what makes it more collapsible.
And the other part of obstructive sleep apnea, which is, I don't know, I think it's kind
of fascinating is that most of the time during the day, we're upright.
And when we're upright, the lungs and the heart, if you will, sort of tug on the trachea
and pull the trachea down, and that's like straightening the tube out, if you will.
And then when we lay down at night, there isn't that pull on the trachea, the airway,
to keep it open.
There's a lot of factors that go into the sleep apnea, maybe a little bit more detail
than you want to know.
But the consequences is that you frequently snore, gasp, and the definition, actual definition
of obstructive sleep apnea is that there has to be cessation of airflow for more than
10 seconds.
So if you watch somebody breathing, a lot of times they slow their breathing down, but
they don't stop breathing for more than 10 seconds, because otherwise that would be a
respiratory rate of six per minute.
That's pretty low, even for a conditioned athlete.
Yeah, indeed, great basic explanation of obstructive sleep apnea.
Are there different types of obstructive sleep apnea, or is that just kind of a big blanket
term?
Not really.
I wouldn't say that there's different types of obstructive sleep apnea.
There's different types of sleep apnea, because there's obstructive and there's also central
sleep apnea.
Central sleep apnea is, I think it's fascinating, because we see more central sleep apnea in
Colorado than probably any place in the country, and that's because of elevation.
So the higher you go up in elevation, the more likely you are to see central sleep apnea.
Central sleep apnea means that there's no signal from the brain through the respiratory
muscles for respiration.
So instead of a noisy type of apnea where with obstruction, when somebody finally breaks
open their airway, there's choking and noise.
With a central sleep apnea, there is no associated noise.
Again, the definition is more than 10 seconds.
So stop breathing.
There's no airflow, but there's no obstruction either.
And the consequences of the physiologic consequences are really different.
And so it's really important, and like I say, particularly in Colorado, because we see a
lot of central sleep apnea here.
At higher elevation, you see a lot of central sleep apnea.
So it's really important to determine, does somebody have central sleep apnea primarily,
or is it primarily obstructive?
Because we don't do anything about central sleep apnea as treatment-wise, usually.
One of the reasons that people are very, I don't know, reticent to investigate their
sleep is because they're afraid that somebody's going to say, yes, you have obstructive sleep
apnea, you need CPAP.
And you just say the word CPAP around a lot of people, particularly males, and they say,
I'm not doing that.
No, there's no way I'm doing CPAP.
Don't even talk to me.
There's no reason to do a study.
But that's not true, because there are other treatment options.
The simplest often being positional therapy, going from one side to the other and staying
off of your back, maybe elevating your head a little bit to take advantage of that aspect
I talked about earlier, a little tug on the trachea holding the airway open, probably
one of the simplest, most effective treatments for obstructive sleep apnea, particularly
if it's only mild or moderate, is a dental appliance.
So very similar to what an athlete would wear, only it's not bulky and ugly.
They're usually quite thin and they should be made by a dentist who is sleep trained.
So believe it or not, there are dentists that have sleep training.
And what they do is they position the, they may need the device and they position the
jaw with various degrees of jaw thrust.
So paramedics, the M&S people are really familiar when they kind of want to sing, somebody's
unconscious, they do a jaw thrust.
And it almost always eliminates the obstruction.
Just do a gentle jaw thrust, you open up the airway.
The dental appliance does the same thing.
And it's really well tolerated.
There's some minor side effects from it, but it's well tolerated.
It's easy to travel with.
You can have it at a fire station, you can have it any place.
Nobody's going to be poking fun at you because you have a machine sitting by your bedside.
It doesn't interfere with anything.
Because if you wake up, you take the dental appliance out, set it in on the bedside table
off, you're done.
You're not trying to rip a mask off or anything like that.
So that's the simplest treatment.
Well, positional therapy, dental appliance, then in more difficult cases or more severe
cases of obstructive apnea, we do CPAP.
Or that's the treatment of choice.
There's now, and I hear people talking about this quite a bit because there's been a significant
amount of ads for this that you'll see on TV for, get rid of your CPAP.
All you need is a remote that fixes your sleep apnea.
And that's been around now for about 15 years, actually.
And what it is, it's an implantable device that implants in the chest, really similar
to a pacemaker.
Only instead of pacing the heart, the wires go up into the nerve and the neck, and that
nerve connects to the tongue.
A specific branch of this nerve connects to the tongue.
And it's timed with respiration so that there's signal sent to the tongue, and it moves the
tongue forward and opens up the airway.
It's very, very high tech.
It is not for everybody.
It's not even for a small percentage.
Very small, small percentage of people will use this and use it effectively.
Yeah, that's a great breakdown of, we've encouraged people throughout this podcast to get a sleep
study done, or at least talk to your primary care doc at the very least, especially if you're
a shift worker, and say, hey, let's talk about sleep, and then potentially, like, hey, let's
do a sleep study if you can get them to refer you or however your insurance works.
And let's make sure that we are resting and recovering appropriately, especially when
we're not at work in the fire service where you might get to sleep at the station.
But if you're a shift worker and you're working nights, daytime sleeping, you want to make
sure that you're rested and recovered as well.
Like that's the whole point of us sleeping.
So it doesn't have to be this big scary beast to go talk to a doctor about sleep.
If it doesn't mean if I use the word sleep, I'm going to instantly get put on CPAP.
And I think you hit it right on the head.
If you hear CPAP, people are like, absolutely not, especially for those of us in emergency
services, because we see them in people's houses all the time.
Most of the time, they're not using them.
But a lot of times, those people that we see that have CPAP next to their bedside are not
always the healthiest population.
So we probably have some cultural correlation to that of, hey, I'm not that old or I'm not
unhealthy, I don't need a CPAP.
So there's a lot of other options out there, which is very, very encouraging.
There's a lot of sleep disorders that people can have that interfere with sleep.
And so if there are certain symptoms, which I'll go over in a minute, but if there's symptoms
that sleep is not good, not good quality.
So there's a difference between quality and quantity.
Obviously, if you cut your quantity of sleep down too much, you're going to have symptoms.
But if you're in bed for eight hours a night and you're still tired and sleepy during the
day, memory is not good, that sort of thing, then it could be a quality issue.
And it's always changing.
But right now, as of today, there are 34 separate sleep diagnoses.
That's a lot.
That does include, I think, eight that are specific to pediatrics.
But I mean, 26 sleep diagnoses for adults, that's a lot.
And there's quite a number of those that are common in adults, like restless leg syndrome,
periodic movement disorder, that interfere with quality of sleep.
So if we're talking just about maximizing sleep, particularly when you're not at work,
then you have to consider these other things too.
Yeah, that's right.
You know, why you would want to go see a sleep specialist.
Indeed, yeah, I didn't know that was going to be my next question.
Let's talk about some sleep disorders, because it's not just all sleep apnea related.
So I didn't know that there was that many, that's really, really interesting.
Now if they're doing a general sleep study, are they going to be able to identify, or
at least, hey, we want something happening, we want to further expand on those 26 adult
sleep disorders?
Or is that like a different sleep study each time to try to find those?
That's a really good question.
Sleep studies are really expensive when they're done in the lab.
And so most insurance companies now won't even pay for an in-law sleep study unless you see
a sleep specialist.
Not all of them, but most of them.
And there's good reason, because for a large number of sleep disorders, just talking to
somebody, you can kind of figure out what the problem is.
So just anecdotally, I had one patient that was brought in by his wife, and she was upset
because of weird behaviors.
And the thing that finally tipped them over was, is that she woke up in the middle of
the night freezing and realized that there was a carton of ice cream sitting on her head.
His sleep behavior was that he had nocturnal eating disorder, so he'd get up at night and
get something to eat, but he was asleep when he was doing it.
So this particular night, he got back in bed and eaten the ice cream and set the carton
of ice cream on her head.
And so we didn't need to put him in the sleep lab.
It was like, oh, okay, I know what you have.
So there's disorders like that.
Same thing like with teeth grinding.
That is a sleep diagnosis, sleep bruxism, teeth grinding.
You talk to somebody, particularly if you have a bed partner, we always try to interview
bed partners as best we can.
You can make the diagnosis just from talking to somebody.
There are times when we really do need to put somebody in the sleep lab and figure it
out.
Yeah, and it's funny as you're telling that story about ice cream or nocturnal sleep eating
or what.
We would call those in the fire service, those are called engineers, the guys and girls that
drive the apparatus.
They're known for having their midnight snacks.
So we would call it the engineer disorder maybe.
And to give some perspective, Dr. Petron's son is a firefighter in the fire service.
And so he kind of understands the culture of what the fire side of this looks like, but
then obviously working as a physician for many, many, many years, he understands the
perspective of EMS and paramedics and things like that.
So just wanted a quick little side note.
But as always on the firefighter craftsmanship podcast, nothing that we're talking about
here should be construed as medical advice.
And so go talk to your primary care physician, do your own research, but talk to the experts
and empower yourselves, take care of your own health journey is really, really important.
So let's talk a little bit more about sleep deprivation.
So can I be sleep deprived and not have a sleep disorder?
I'm going to back up just a little bit.
The sleep, just to me, is so darn fascinating because it's changing within society.
So the American Academy of Sleep Medicine does these gigantic studies and issues, these
papers that are very important because that's where the data comes for like CDC.
And they showed that in the last, in 2015, when the study was completed, that more than
70 million Americans were in the US, 70 million adults, I should say, were getting less than
six hours of sleep per 24 hours on a regular basis.
And that was up dramatically from the last big survey, which I think was done in 2002,
maybe 2005.
So it's increased.
And because of this, it was a gigantic study.
The CDC actually declared it public health epidemic because of sleep, they call it sleep
restriction.
So there's a difference between restricting your sleep because of societal issues.
You've got work, you've got a family, you're going to athletic games for your kids.
You're doing other things and that's restricting your sleep time.
So that's why I say it's just sort of fascinating is that this is becoming more of a, almost
more of a societal problem.
Before it was shift work.
And that shift work has been around for a long time in the US.
But these other societal things, and a lot of it comes from screening time, as you might
imagine.
Screen time being bad for a lot of reasons because it's stimulating.
They've sort of shown that it stimulates the pleasure part of the brain, these little
video clips.
And then of course, there's the light aspect, the blue light aspect, which is also affecting
sleep.
There is innumerable sleep deprivation studies done both in animals and humans that show
this very, very strong association with cardiovascular risk, mental health issues, depression, weight
gain because sleep deprivation alters the hormones responsible for appetite increases the hormone
that makes us want to eat more.
When we eat more, we don't eat the right calories.
So that's associated with weight gain, associated with diabetes, cancer.
There's some really alarming studies in that were done in night nurses that showed an increase
in breast cancer and in ovarian cancer.
And I've actually had discussions with my son about this because in the past, the fire
service, they've clearly established they have higher incidence of cancer.
But it's hard to sort out, is it because of exposure to carcinogens or is it because of
sleep deprivation?
And we know that sleep deprivation results in immune system dysfunction, which is probably
why there's this increased risk for cancer.
Talked about the cultural changes and cultural implications of sleep just for societal factors
initially, and then the advent of technology and the technology companies, all the social
media platforms, they're hiring the greatest minds in science because their trade is eyeballs.
And so the longer that they can keep you on their platform, the more money that they make.
And so it's really, really important for them to hire the best physiologists and psychologists
and medical professionals to work for their companies to figure out how can we keep people
on our platforms longer by targeting the dopamine receptors and things like that, the pleasure
sides of the brain.
And so really, really interesting correlation.
But then you also talked about the busyness of life, regardless if you're on a 24-hour
shift or you work a regular 40-hour week, you're still busy, busy, busy.
Just societal has changed for sure.
And then we stay up watching Netflix, Two Haters, whatever.
Or areas of the country would be the same as well.
So if you look at the East Coast, and then there's a Stanley Cup hockey game, but those
teams are on the West Coast, well, the East Coast viewers are staying up a lot later than
the West Coast viewers are for simple things like TV programming.
So there's this massive thing of culture.
And I think it's really important for us in emergency services to start having these conversations
organizationally, especially because the decision makers typically are on a quote unquote 40-hour
work week.
They're working Monday through Friday, they're working days, they sleep in their own bed at
night.
But they are making decisions.
And yes, a lot of those people are extremely overworked and they're choosing to work way
more than 40 hours a week.
That's not the debate that we're going to have.
But they're making decisions for people that are an EMS where they might be working overnight.
So working 12-hour shifts.
But that decision maker is at home sleeping in their own bed every single night, seven
days a week.
And so same thing in the fire service, right?
Where the heads of departments are making decisions, but they go home every single night and they
sleep in their own beds.
And the fire service is different than when they were online.
It's just a matter of fact that every year, every department is getting busier and busier
and busier because of cultural changes.
The baby boomers are getting older.
There's lots and lots of areas that we could expand to prove what we're kind of talking
about.
But I think it's a really, really important tangent to go down of culture impacts sleep.
And so organizationally, we have cultures organizationally that we get to ebb and flow
and drive positive or negative change within culture and sleep needs to be at the forefront
of that.
And then you tied it in perfectly of saying, hey, cardiac depression, mental health, which
is tied to suicide, right?
And cancer, the big one, cancer rates.
And we're having in the fire service specifically, we know that not including cancer, 50% of our
line of duty deaths every single year are cardiac related.
So if sleep impacts cardiac health, we're doing things around fitness and the wellness
fitness initiative and all these sorts of things.
But there's very little chatter about sleep.
There's nothing mentioned about sleep in most of these documents at all.
And they're talking about cardiac health.
And we can host literally hundreds of studies in relation to cardiac and sleep specifically.
And now the big one is cancer.
And so don't wear your gear.
Don't put it in the cab.
Make sure it's always clean.
All this stuff and not a single mention about sleep.
And it's just wrong for us to continue down this path and say, well, it's because your
gear was dirty or the stuff that's burning is different.
Yes, it's made out of plastic.
We understand that it throws some nasty chemicals out there.
But we're ignoring, it's not even an elephant in the room, right?
It's like a whole entire herd of elephants that sleep creates immune system deficiency.
Which is directly correlated to getting sick and directly correlated to fighting off things
like cancer cells.
I really applaud you for bringing this to the forefront and talking about it.
Having been around for a long time, I've sort of seen how hard it is to make changes.
Big example is school start times.
We've known about the sleep physiology and the fact that a teenager, they want to go
to bed later at night, get up later in the morning.
But we were starting their school times early.
And it took years and years and years of pounding this message into administrators before they
actually changed to sleep times.
And the data is overwhelming that it improved learning, decreased car accidents, all kinds
of things.
But what you brought up about hockey and it made me think about the fact that sleep is
so important now that teams, professional teams, not just professional teams, but a lot
of professional teams have a sleep medicine doctor on their roster and not roster in their
organization to help with very specific scheduling issues to improve sleep because it affects
performance, absolutely affects performance.
And we're talking athletic performance, which it's not just athletic performance.
It's also cognitive aspects too, because athletes have to think about what they're going to
do so there's a cognitive aspect of them too.
And I'm really worried about, I'm always worried about EMS folks, nurses that work by
shift, that sort of thing and the effect on their daytime functioning.
So the fact that you're stirring this up, bringing it up is super good because the solutions
are out there.
There are solutions and people may not like to hear about them, but there are solutions.
And some of the things which really, really goes against the fire service is taking maps.
Maps are unbelievably restorative and that again, the data is there that if you sleep
deprived somebody and you compare them to somebody that you've given even to so much
as a 20 minute nap to, the difference in performance is remarkable.
So why don't we do this?
Even the airlines who have been really reticent to do anything know that they have to give
their pilots that are doing these transcontinental flights that are in the air for eight hours.
They have to give them some time to lay down or rest or sleep or whatever, let the co-pilot
take over and their performance is better.
Their performance and alertness is better.
It's simple.
It's not hard stuff, but it goes against these cultures that have been ingrained in us.
Yeah.
Now, the big one is if I lay down and I take a nap, then I'm lazy.
Right?
Yep.
Oh yeah.
Of course.
And I know nothing to do with lasers.
Yeah.
Not at all.
I know some high performers that sleep a lot.
I know some high performers for now at least that don't sleep very much.
And I know some extremely lazy people that are not high performers that don't sleep at
all.
Right?
They stay up really, really long or they sleep a bunch.
Right?
It has nothing to do with that.
That's just that cultural tag of, well, that person's lazy or not a high performer.
And I think you hit it right on the head is a lot of these solutions that are out there
are actually free.
They don't cost any money.
And even if we look at it from a production standpoint, well, if they're sleeping, then
they're not out there doing whatever, public education, inspections, like all these things,
emergency services, training.
Well, yeah.
Okay.
Would you rather have a person that took some downtime and now they go and they train and
they actually process and learn the information?
Or do they just show up to the training and they were up all night and now they try to
survive until you are finally done blabbering or killing them by PowerPoint and they can
go home or go back to now actually perform the job that we were tasked to do with if
you're on a 48 hours sort of schedule and not remember anything that was just talked
about.
So production goes up when we have well rested members of our teams.
There's a lot of data about that too, about memory and how important about, you can argue
a lot about what the purpose of sleep is and just, you know, why do we sleep?
That question always comes up.
But for sure, one of the things that it does, it does is it takes our memories from short
term and puts it into long term areas in the brain so that we can actually retain what
we've learned.
And when you do sleep restriction or sleep deprivation, whatever term you want to use,
you know, it affects your ability to learn and memory during the day as well.
So what is your suggestion for those of us that work a shift that isn't a 24 hour shift
so let's say a police or EMS?
We know that they should at least stick on those same shifts.
So if you're working nights, you should stay nights and you see this a lot with physicians.
I was just talking to a physician the other day where, you know, they take call or they're
on rotation in the operating room and they might be working days and now they have to
take call and now they're up all night.
And yeah, they might have that next day off, but then now they're back at days and then
they got to take call at night.
And so they don't have like, and it's not like every Thursday they have call, right?
It's on a rotational schedule.
And so they don't have a lot of consistency either.
And they're essentially working 24 hour shifts, but they're not in the fire service, you
know, but they also work day shifts.
So what are some suggestions like for police officers or some departments, you know, they
try to share the load a little bit across the country and they say, all right, for now
you're working days, and then you go to swing shifts and then you do nights and they're
kind of sporadic and it's on a three month rotation or something like that.
But isn't that actually worse for them than if they would just be have a night shift where
they can create some consistency around those circadian rhythms?
Sure.
Ideally, you don't want to, you don't want to change your shift at all, but because
there's a pay differential, you know, a lot of places there's a pay differential if you
work night shift.
And so there are ways to mitigate those effects, but there is also, so there's a couple principles.
One is that you, if you're shifting your time, you want to always go forward, not backwards.
So it's easier for us to go to bed later and get up later than it is to go to bed earlier.
I mean, just try it.
If you're on, you know, if you generally work your days, try to go to bed and go to sleep
at six o'clock at night.
It's this darn near impossible.
But you can stay up and go to bed at three in the morning and fall right to sleep.
Most likely you will fall right to sleep.
So it's always easier if you're delaying your sleep.
So that's, that's one principle that a lot of companies don't believe in.
I don't know why I got into a really not a good situation with the company in Northern
Colorado when I recommended that they quit going backwards.
So making people go from nights to evenings to days, which is exactly the absolute long
way to do it.
But there's things like that.
The other thing is that if you, it's really helpful if you understand what controls our
sleep.
So in the big picture, sleep is controlled by two things, circadian rhythm.
And for humans, most mammals, not all, but for humans, your circadian rhythm is based
on sleeping at dark and being awake during the light.
And that's what entrains our sleep in this 24 hour cycle.
The other thing that controls sleep is, well, the official name is the homeostatic function,
but I always consider it the pressure to sleep.
So the longer you're awake, the more pressure there is on your brain to sleep.
So if you're up for 24 hours, the pressure to sleep is really great.
And the only way to get rid of that is to sleep.
The problem is, is if you start your day at seven in the morning, you go seven in the
morning, the next day, then circadian rhythm kicks in and it wants to wake you up in the
morning.
So there's things you can do with light and napping at certain times and melatonin.
It's a very complicated thing and you can actually really mess people up if you get
the timing long, which is why a lot of these athletic teams hire a sleep physician or sleep
PA or whatever to help them with their schedules.
Specifically, let's just take, for example, an officer that's a police officer that goes
on duty at five at night and gets off at five in the morning.
The thing that they can do to help them sleep during the day is don't get exposed to bright
light.
So this is something I was always telling the night nurses to do.
Put your dark glasses on before you walk out of the building and see sunlight.
Really dark glasses.
You wear your dark glasses till you get home and then you try to get into a dark room because
light is so alerting to the brain.
One of the things that entrains us, as I said, entrains asleep.
So that's a really simple thing to do for people, but I've told people to do this many
times in the past that and they don't do it.
I don't know why, but it's very simple.
And it's just by having the knowledge of what controls our sleep.
And then you can use the pressure to sleep also as a positive to help you sleep because
the longer you're up, the more you're going to want to sleep.
But you have to go to a quiet, cool, dark place to sleep, not sleeping in your car in
the sunlight.
If that makes sense.
Yeah.
I mean, you can do that.
If you're super sleepy, you'll fall asleep in your car in the sunlight.
But that's not ideal.
What you want to do is get several hours of sleep.
And then the other technique, which is really, really important is taking a nap, no matter
how brief it is before you go on one of these long stretches or a night shift.
So if you know you're going to do 24 hours and you're going to be up for 24 hours, well,
depending on when you start your shift may not be possible to do a nap, but taking the
example of the officer that's going to be up from 5pm to 5am, if they take a nap in
the afternoon right before their shift, that helps them stay more alert.
So there's a lot of little things to do like that, not exercising right before you're going
to sleep, that kind of thing.
That's all considered sleep hygiene stuff.
Yeah, fantastic.
And a lot of that plays into biology and physiology and hormone release and all that
stuff.
So what kind of tricks do you have for, you know, in the fire service where we have no
idea when the 911 call is going to come in.
And so we, you know, we choose to go to work and we choose to respond to the best of our
ability every time that we go to shift.
But some people, you know, if they wake up 2, 3 in the morning, they have a really, really
hard time falling back asleep.
And they might toss and turn until they have to get up either for shift change or they
got to get up for other organizational duties or they just get frustrated and they get up,
let's say 6, 7 in the morning.
So what kind of interventions or suggestions would you have for somebody like that that
has a hard time falling back asleep?
Yeah, that's a very difficult and surprisingly common problem because one of the things that
happens as you well know, even if you've been in the fire service for a long time and you're
used to getting these calls, it still causes an adrenaline rush.
That adrenaline stays around for a while and it is highly stimulating and it's also very
wake promoting.
It's one of the dopamine and adrenaline and those are wake promoting neurotransmitters.
So if you can't get yourself settled down in that setting, then it's really, it's hard
to deal with because it's a neurochemical issue that's keeping you from falling asleep.
The other big thing and we probably don't have time to really delve into this a lot,
but it's a concept that I'd like people to think about because it's unbelievably important
and it is the principle that drives treatment for insomnia and that is that we condition
ourselves all the time and if you have trouble falling asleep in your bed and you lay there
for 30 minutes, you only now what you've done is you negatively conditioned yourself even
more to not be able to sleep there.
So one of the principles which people do not like and will always fight with me about is
if you're not sleeping in your bed, you have to get out of the bed and do something else
because for whatever reason, that negative conditioning is super powerful and it will
keep you awake.
So you got to get up, you got to go somewhere else and do something not too stimulating
like not going into the weight room and working out real hard and then trying to go back to
sleep.
That ain't got to work.
It's a principle.
Yeah.
That's where the engineer nighttime feeding sesh usually happens, right?
They go to the fridge when they get back from a call.
Is that a good idea or not to eat when you're awake to eat half a gallon of ice cream and
then try to go to sleep?
Well, unfortunately, when you eat a meal, you get all kinds of, and it doesn't have to
be a big meal, but if you eat very much, there's hormones that are released from the GI tract
that are vaguely weight promoting.
So maybe a couple of graham crackers and drink and some milk or something like that's okay,
but fiction nachos and that sort of thing, probably not a good idea.
The problem is, is like I said before, is that sleep deprivation increases the hormone
that makes us want to eat more, increases that up to time.
Why that affects engineers?
I don't know, but that might explain a little bit of my son's eating habits.
I don't know.
There you go.
That's why I'm picking on engineers because your son is an engineer.
Yeah.
That's great stuff.
Can we talk real quick?
We're almost out of time.
I don't want to take too much of your time, but can we talk really quickly about alcohol?
And obviously at work, we should not be drinking alcohol.
And if you are, you need to definitely talk to a provider about that's not a great choice.
So when our days are off and we hear a lot of people, oh, I have a couple drinks and
it helps me fall asleep.
Can you talk a little bit about the interaction of alcohol and what it actually does to our
sleep?
The alcohol, it does help people fall asleep.
It does decrease the amount of time that it takes to fall asleep.
The problem is, is that after everything is metabolized, the brain wakes up like three
to four hours later and is more or less in a, I don't want to use the word agitated,
but that's what it is, sort of an agitated state, a restless state.
And so sure, you'll get two to three good hours of sleep, maybe four from alcohol.
But then you pay the price the rest of the night and your overall quality is that good.
What I've always told people, and I think that the physiology backs it up, is that you
want to drink alcohol.
You should try really hard to be done drinking your alcohol two hours before you go to sleep
and make sure that you push fluence because alcohol dehydrates us.
And that's another thing that tends to wake us up.
I consider that a drug and most companies don't scream for alcohol unless you're visibly
drunk on the chop or something.
But yeah, lots and lots of medications back sleep.
Yeah, and you notice that I never once said anything about using a drug to help us sleep
because generally speaking, it's not anything.
You gave us some great stuff here.
I learned quite a bit.
And I think one of the biggest ones is where you talked about the routine, especially for
those of us, you may be that wake up and have a hard time falling back asleep.
Well, the routine shouldn't include jumping on your cell phone and looking at social media
or watching YouTube videos or whatever.
That those things that are intentionally targeting the dopamine receptors, which helps
us actually wake up.
It's not going to help you fall asleep.
So establish those routines.
Some things I've tried to help coach people on is what's the routine before you go to
sleep?
Even if they're good about, hey, I plugged my phone in at home.
It's in the bathroom.
I don't have access to it.
So I'm limiting my bed to a couple of things.
So what are those routines?
And then trying to replicate those at your place of work if you're in the fire service
where you can sleep on duty.
You brush your teeth.
Place cold dark room, all those sorts of things.
And then maybe trying to replicate some of those things when you come back from a call,
right?
Going in the bathroom, not turning all the lights on.
Maybe all as far as brushing your teeth again, like cold water on your face or warm water
on your hands and your face to cool down the inner temperatures, like all of those sorts
of things that we're starting to learn more and more about, which is really, really cool.
To establish those routines and try to keep them consistent from at home and at work.
Or if you're traveling, like try to keep your routines consistent as much as possible.
And your brain correlates, hey, I'm supine in a dark environment.
It's comfy.
I have the perfect pillow.
It's time to go to sleep.
Absolutely.
Well, thank you, Dr. Petron.
We really appreciate your knowledge and expertise on this and just a great, basic, easily to
digest, easy to digest format for us.
We really, really appreciate it.
Lots of resources on sleep specifically at firefightercraftsmanship.com.
And so head over there.
And we also have this series of podcasts specifically that talks about all different types of sleep
interventions or why sleep matters and things like that.
How we can control the controllables.
We're not trying to say we don't need to run 911 calls in the middle of the night like
that thing exists.
But how can we control around that, whether that's organizational cultures, personal cultures,
even all the way down to gasp, what do our shifts actually look like?
And maybe it's time to start looking at other options, things like the 2472 to allow people
rest in recovery.
So that when they come back to work, they're focused and they're happy, healthy and strong,
both at work and off the job.
So thank you again, Dr. Petron.
Much appreciated.
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