1 00:00:00,000 --> 00:00:10,400 It's hard to sort out, is it because of exposure to carcinogens or is it because of sleep deprivation? 2 00:00:10,400 --> 00:00:17,520 We know that sleep deprivation results in immune system dysfunction, which is probably 3 00:00:17,520 --> 00:00:24,600 why there's this increased risk for cancer. 4 00:00:24,600 --> 00:00:28,960 Welcome to the Firefighter Crascmanship Podcast, where we give you real tools to train ultimate 5 00:00:28,960 --> 00:00:32,440 humor performance both on and off the emergency scene. 6 00:00:32,440 --> 00:00:34,440 I'm your host, Kevin Housley. 7 00:00:34,440 --> 00:00:35,440 Let's get to it. 8 00:00:35,440 --> 00:00:38,680 All right, welcome back to the Firefighter Crascmanship Podcast. 9 00:00:38,680 --> 00:00:45,320 Today, we have a very special guest, Dr. Mark Petron, and we're going to dive into sleep, 10 00:00:45,320 --> 00:00:49,600 the nice fun topic of sleep in relation to shift work. 11 00:00:49,600 --> 00:00:53,560 And we're excited to have Dr. Petron here with us today. 12 00:00:53,560 --> 00:00:55,040 So welcome to the show. 13 00:00:55,040 --> 00:00:57,040 Thank you very much. 14 00:00:57,040 --> 00:00:58,800 It's great having me. 15 00:00:58,800 --> 00:01:03,000 I'm very excited to kind of ask you some of these pressing questions that we have, but 16 00:01:03,000 --> 00:01:05,560 we're going to basically keep it really, really simple. 17 00:01:05,560 --> 00:01:07,400 There's a lot of chatter out there about sleep. 18 00:01:07,400 --> 00:01:11,120 You know, Dr. Matthew Walker wrote a book about why we sleep. 19 00:01:11,120 --> 00:01:15,600 It's just gotten a lot of really good positive press, and it's kind of got some really fun 20 00:01:15,600 --> 00:01:21,600 conversations started in a lot of our organizations, or at least with us personally. 21 00:01:21,600 --> 00:01:25,320 But then that kind of stops as far as sleep. 22 00:01:25,320 --> 00:01:27,200 How do we maybe implement some of this stuff? 23 00:01:27,200 --> 00:01:29,400 How does it apply to us as shift workers? 24 00:01:29,400 --> 00:01:34,480 So I'm excited to kind of talk to you today about that. 25 00:01:34,480 --> 00:01:40,960 So you started your Doctor of Pulmonology, and how did you get involved in the whole 26 00:01:40,960 --> 00:01:42,480 sleep aspect? 27 00:01:42,480 --> 00:01:45,200 Why does a pulmonologist care about sleep? 28 00:01:45,200 --> 00:01:50,040 Yeah, that's an excellent question. 29 00:01:50,040 --> 00:01:59,320 Because primarily the sleep problem that most people have or have knowledge about is obstructive 30 00:01:59,320 --> 00:02:01,240 sleep apnea. 31 00:02:01,240 --> 00:02:08,120 And we, in our training and pulmonary training, we all learn about obstructive sleep apnea. 32 00:02:08,120 --> 00:02:16,440 Me personally, when I was doing my fellowship, we had a sleep lab, which back in the day 33 00:02:16,440 --> 00:02:25,440 was somewhat unusual, and my research project was looking at control of breathing during 34 00:02:25,440 --> 00:02:29,680 sleep, which is different than control of breathing awake. 35 00:02:29,680 --> 00:02:36,240 So that's how I personally got started, but a lot of pulmonary doctors end up going down 36 00:02:36,240 --> 00:02:38,360 to sleep, Rob. 37 00:02:38,360 --> 00:02:43,480 So if we end up doing a sleep study or something like that, are you going to potentially see 38 00:02:43,480 --> 00:02:48,840 a pulmonologist or are you going to see some sort of sleep specialist? 39 00:02:48,840 --> 00:02:59,200 So nowadays, sleep medicine is a specialty, and it's actually a fellowship trained specialty. 40 00:02:59,200 --> 00:03:05,840 So when I was training, it wasn't that way. 41 00:03:05,840 --> 00:03:15,400 So I did a lot of additional courses over the years, and that's how I became trained, 42 00:03:15,400 --> 00:03:17,320 not in a formal fellowship. 43 00:03:17,320 --> 00:03:21,280 But now there's quite a few sleep medicine doctors. 44 00:03:21,280 --> 00:03:27,960 And when people have significant problems with sleep, a lot of times that's the best 45 00:03:27,960 --> 00:03:31,360 place to start is with a sleep specialist. 46 00:03:31,360 --> 00:03:32,360 Fantastic. 47 00:03:32,360 --> 00:03:34,560 Well, it's nice that there's more of them out there now. 48 00:03:34,560 --> 00:03:38,760 So you might actually get an appointment if you want one, right? 49 00:03:38,760 --> 00:03:39,760 For sure. 50 00:03:39,760 --> 00:03:43,560 So when did you start practicing as an MD? 51 00:03:43,560 --> 00:03:45,560 Oh, 1981. 52 00:03:45,560 --> 00:03:47,560 Okay. 53 00:03:47,560 --> 00:03:50,400 So you've been in the game a long time. 54 00:03:50,400 --> 00:03:55,320 You've seen positives and negatives all the way with medicine, and then especially in 55 00:03:55,320 --> 00:03:59,920 the sleep space, no doubt about it, where, like you said, during your fellowship, there 56 00:03:59,920 --> 00:04:03,320 wasn't necessarily like a sleep doctor. 57 00:04:03,320 --> 00:04:06,240 It was more of the pulmonology route. 58 00:04:06,240 --> 00:04:10,240 Sleep medicine has exploded since the 1990s. 59 00:04:10,240 --> 00:04:17,320 I think I got my first sleep medicine certification in 1991 or 1992. 60 00:04:17,320 --> 00:04:20,920 I don't remember exactly. 61 00:04:20,920 --> 00:04:24,880 But that's because there wasn't certifications before then. 62 00:04:24,880 --> 00:04:25,880 Yeah. 63 00:04:25,880 --> 00:04:26,880 Okay. 64 00:04:26,880 --> 00:04:27,880 Fantastic. 65 00:04:27,880 --> 00:04:32,400 So can you kind of describe to us, for those of us that don't know, what is obstructive 66 00:04:32,400 --> 00:04:34,520 sleep apnea? 67 00:04:34,520 --> 00:04:36,080 Yeah. 68 00:04:36,080 --> 00:04:47,240 So obstructive sleep apnea, as most of us think about it, is it's when you're asleep 69 00:04:47,240 --> 00:04:49,120 and you obstruct your airway. 70 00:04:49,120 --> 00:04:54,720 And the level of obstruction of the airway is usually soft palate. 71 00:04:54,720 --> 00:05:00,760 So if you think about it, if you go straight back through your mouth, there's hard palate, 72 00:05:00,760 --> 00:05:05,240 and there's the epiglottis, that thing that hangs down in the back, and that's the part 73 00:05:05,240 --> 00:05:12,960 of the, that's generally the part that is obstructing. 74 00:05:12,960 --> 00:05:21,520 And it's more complicated than that because the musculature that holds our airway open, 75 00:05:21,520 --> 00:05:26,960 when we go to sleep, that tone decreases, the tone in the airway. 76 00:05:26,960 --> 00:05:32,400 It's kind of like the tone in our skeletal muscles too, but the tone in the airway decreases 77 00:05:32,400 --> 00:05:39,120 and that's what makes it more collapsible. 78 00:05:39,120 --> 00:05:43,080 And the other part of obstructive sleep apnea, which is, I don't know, I think it's kind 79 00:05:43,080 --> 00:05:49,520 of fascinating is that most of the time during the day, we're upright. 80 00:05:49,520 --> 00:05:59,320 And when we're upright, the lungs and the heart, if you will, sort of tug on the trachea 81 00:05:59,320 --> 00:06:06,000 and pull the trachea down, and that's like straightening the tube out, if you will. 82 00:06:06,000 --> 00:06:13,280 And then when we lay down at night, there isn't that pull on the trachea, the airway, 83 00:06:13,280 --> 00:06:14,280 to keep it open. 84 00:06:14,280 --> 00:06:21,200 There's a lot of factors that go into the sleep apnea, maybe a little bit more detail 85 00:06:21,200 --> 00:06:23,360 than you want to know. 86 00:06:23,360 --> 00:06:34,720 But the consequences is that you frequently snore, gasp, and the definition, actual definition 87 00:06:34,720 --> 00:06:41,360 of obstructive sleep apnea is that there has to be cessation of airflow for more than 88 00:06:41,360 --> 00:06:43,840 10 seconds. 89 00:06:43,840 --> 00:06:51,080 So if you watch somebody breathing, a lot of times they slow their breathing down, but 90 00:06:51,080 --> 00:06:57,200 they don't stop breathing for more than 10 seconds, because otherwise that would be a 91 00:06:57,200 --> 00:07:02,320 respiratory rate of six per minute. 92 00:07:02,320 --> 00:07:06,960 That's pretty low, even for a conditioned athlete. 93 00:07:06,960 --> 00:07:14,040 Yeah, indeed, great basic explanation of obstructive sleep apnea. 94 00:07:14,040 --> 00:07:18,200 Are there different types of obstructive sleep apnea, or is that just kind of a big blanket 95 00:07:18,200 --> 00:07:22,640 term? 96 00:07:22,640 --> 00:07:23,640 Not really. 97 00:07:23,640 --> 00:07:27,400 I wouldn't say that there's different types of obstructive sleep apnea. 98 00:07:27,400 --> 00:07:35,400 There's different types of sleep apnea, because there's obstructive and there's also central 99 00:07:35,400 --> 00:07:37,320 sleep apnea. 100 00:07:37,320 --> 00:07:46,240 Central sleep apnea is, I think it's fascinating, because we see more central sleep apnea in 101 00:07:46,240 --> 00:07:57,320 Colorado than probably any place in the country, and that's because of elevation. 102 00:07:57,320 --> 00:08:03,920 So the higher you go up in elevation, the more likely you are to see central sleep apnea. 103 00:08:03,920 --> 00:08:09,840 Central sleep apnea means that there's no signal from the brain through the respiratory 104 00:08:09,840 --> 00:08:13,440 muscles for respiration. 105 00:08:13,440 --> 00:08:21,680 So instead of a noisy type of apnea where with obstruction, when somebody finally breaks 106 00:08:21,680 --> 00:08:26,240 open their airway, there's choking and noise. 107 00:08:26,240 --> 00:08:29,600 With a central sleep apnea, there is no associated noise. 108 00:08:29,600 --> 00:08:32,120 Again, the definition is more than 10 seconds. 109 00:08:32,120 --> 00:08:33,920 So stop breathing. 110 00:08:33,920 --> 00:08:39,000 There's no airflow, but there's no obstruction either. 111 00:08:39,000 --> 00:08:46,880 And the consequences of the physiologic consequences are really different. 112 00:08:46,880 --> 00:08:52,320 And so it's really important, and like I say, particularly in Colorado, because we see a 113 00:08:52,320 --> 00:08:56,200 lot of central sleep apnea here. 114 00:08:56,200 --> 00:08:59,480 At higher elevation, you see a lot of central sleep apnea. 115 00:08:59,480 --> 00:09:04,360 So it's really important to determine, does somebody have central sleep apnea primarily, 116 00:09:04,360 --> 00:09:06,080 or is it primarily obstructive? 117 00:09:06,080 --> 00:09:12,680 Because we don't do anything about central sleep apnea as treatment-wise, usually. 118 00:09:12,680 --> 00:09:18,400 One of the reasons that people are very, I don't know, reticent to investigate their 119 00:09:18,400 --> 00:09:22,920 sleep is because they're afraid that somebody's going to say, yes, you have obstructive sleep 120 00:09:22,920 --> 00:09:25,960 apnea, you need CPAP. 121 00:09:25,960 --> 00:09:32,840 And you just say the word CPAP around a lot of people, particularly males, and they say, 122 00:09:32,840 --> 00:09:33,840 I'm not doing that. 123 00:09:33,840 --> 00:09:35,840 No, there's no way I'm doing CPAP. 124 00:09:35,840 --> 00:09:37,600 Don't even talk to me. 125 00:09:37,600 --> 00:09:40,200 There's no reason to do a study. 126 00:09:40,200 --> 00:09:45,400 But that's not true, because there are other treatment options. 127 00:09:45,400 --> 00:09:52,160 The simplest often being positional therapy, going from one side to the other and staying 128 00:09:52,160 --> 00:09:59,280 off of your back, maybe elevating your head a little bit to take advantage of that aspect 129 00:09:59,280 --> 00:10:05,400 I talked about earlier, a little tug on the trachea holding the airway open, probably 130 00:10:05,400 --> 00:10:12,080 one of the simplest, most effective treatments for obstructive sleep apnea, particularly 131 00:10:12,080 --> 00:10:18,160 if it's only mild or moderate, is a dental appliance. 132 00:10:18,160 --> 00:10:26,720 So very similar to what an athlete would wear, only it's not bulky and ugly. 133 00:10:26,720 --> 00:10:35,280 They're usually quite thin and they should be made by a dentist who is sleep trained. 134 00:10:35,280 --> 00:10:40,080 So believe it or not, there are dentists that have sleep training. 135 00:10:40,080 --> 00:10:45,580 And what they do is they position the, they may need the device and they position the 136 00:10:45,580 --> 00:10:50,920 jaw with various degrees of jaw thrust. 137 00:10:50,920 --> 00:10:56,400 So paramedics, the M&S people are really familiar when they kind of want to sing, somebody's 138 00:10:56,400 --> 00:11:01,520 unconscious, they do a jaw thrust. 139 00:11:01,520 --> 00:11:05,200 And it almost always eliminates the obstruction. 140 00:11:05,200 --> 00:11:08,880 Just do a gentle jaw thrust, you open up the airway. 141 00:11:08,880 --> 00:11:12,320 The dental appliance does the same thing. 142 00:11:12,320 --> 00:11:15,280 And it's really well tolerated. 143 00:11:15,280 --> 00:11:20,520 There's some minor side effects from it, but it's well tolerated. 144 00:11:20,520 --> 00:11:22,600 It's easy to travel with. 145 00:11:22,600 --> 00:11:25,960 You can have it at a fire station, you can have it any place. 146 00:11:25,960 --> 00:11:30,760 Nobody's going to be poking fun at you because you have a machine sitting by your bedside. 147 00:11:30,760 --> 00:11:32,840 It doesn't interfere with anything. 148 00:11:32,840 --> 00:11:39,000 Because if you wake up, you take the dental appliance out, set it in on the bedside table 149 00:11:39,000 --> 00:11:40,000 off, you're done. 150 00:11:40,000 --> 00:11:44,800 You're not trying to rip a mask off or anything like that. 151 00:11:44,800 --> 00:11:47,920 So that's the simplest treatment. 152 00:11:47,920 --> 00:11:56,760 Well, positional therapy, dental appliance, then in more difficult cases or more severe 153 00:11:56,760 --> 00:12:01,040 cases of obstructive apnea, we do CPAP. 154 00:12:01,040 --> 00:12:04,320 Or that's the treatment of choice. 155 00:12:04,320 --> 00:12:12,560 There's now, and I hear people talking about this quite a bit because there's been a significant 156 00:12:12,560 --> 00:12:21,080 amount of ads for this that you'll see on TV for, get rid of your CPAP. 157 00:12:21,080 --> 00:12:26,200 All you need is a remote that fixes your sleep apnea. 158 00:12:26,200 --> 00:12:35,120 And that's been around now for about 15 years, actually. 159 00:12:35,120 --> 00:12:40,720 And what it is, it's an implantable device that implants in the chest, really similar 160 00:12:40,720 --> 00:12:43,400 to a pacemaker. 161 00:12:43,400 --> 00:12:52,000 Only instead of pacing the heart, the wires go up into the nerve and the neck, and that 162 00:12:52,000 --> 00:12:55,320 nerve connects to the tongue. 163 00:12:55,320 --> 00:13:00,120 A specific branch of this nerve connects to the tongue. 164 00:13:00,120 --> 00:13:05,400 And it's timed with respiration so that there's signal sent to the tongue, and it moves the 165 00:13:05,400 --> 00:13:08,360 tongue forward and opens up the airway. 166 00:13:08,360 --> 00:13:11,800 It's very, very high tech. 167 00:13:11,800 --> 00:13:13,920 It is not for everybody. 168 00:13:13,920 --> 00:13:16,640 It's not even for a small percentage. 169 00:13:16,640 --> 00:13:24,000 Very small, small percentage of people will use this and use it effectively. 170 00:13:24,000 --> 00:13:31,040 Yeah, that's a great breakdown of, we've encouraged people throughout this podcast to get a sleep 171 00:13:31,040 --> 00:13:36,080 study done, or at least talk to your primary care doc at the very least, especially if you're 172 00:13:36,080 --> 00:13:42,240 a shift worker, and say, hey, let's talk about sleep, and then potentially, like, hey, let's 173 00:13:42,240 --> 00:13:48,000 do a sleep study if you can get them to refer you or however your insurance works. 174 00:13:48,000 --> 00:13:54,120 And let's make sure that we are resting and recovering appropriately, especially when 175 00:13:54,120 --> 00:14:00,200 we're not at work in the fire service where you might get to sleep at the station. 176 00:14:00,200 --> 00:14:05,440 But if you're a shift worker and you're working nights, daytime sleeping, you want to make 177 00:14:05,440 --> 00:14:08,200 sure that you're rested and recovered as well. 178 00:14:08,200 --> 00:14:09,800 Like that's the whole point of us sleeping. 179 00:14:09,800 --> 00:14:15,560 So it doesn't have to be this big scary beast to go talk to a doctor about sleep. 180 00:14:15,560 --> 00:14:21,080 If it doesn't mean if I use the word sleep, I'm going to instantly get put on CPAP. 181 00:14:21,080 --> 00:14:22,760 And I think you hit it right on the head. 182 00:14:22,760 --> 00:14:28,040 If you hear CPAP, people are like, absolutely not, especially for those of us in emergency 183 00:14:28,040 --> 00:14:31,560 services, because we see them in people's houses all the time. 184 00:14:31,560 --> 00:14:33,920 Most of the time, they're not using them. 185 00:14:33,920 --> 00:14:39,200 But a lot of times, those people that we see that have CPAP next to their bedside are not 186 00:14:39,200 --> 00:14:41,040 always the healthiest population. 187 00:14:41,040 --> 00:14:47,680 So we probably have some cultural correlation to that of, hey, I'm not that old or I'm not 188 00:14:47,680 --> 00:14:49,560 unhealthy, I don't need a CPAP. 189 00:14:49,560 --> 00:14:54,640 So there's a lot of other options out there, which is very, very encouraging. 190 00:14:54,640 --> 00:15:01,840 There's a lot of sleep disorders that people can have that interfere with sleep. 191 00:15:01,840 --> 00:15:10,360 And so if there are certain symptoms, which I'll go over in a minute, but if there's symptoms 192 00:15:10,360 --> 00:15:14,200 that sleep is not good, not good quality. 193 00:15:14,200 --> 00:15:17,760 So there's a difference between quality and quantity. 194 00:15:17,760 --> 00:15:22,960 Obviously, if you cut your quantity of sleep down too much, you're going to have symptoms. 195 00:15:22,960 --> 00:15:29,600 But if you're in bed for eight hours a night and you're still tired and sleepy during the 196 00:15:29,600 --> 00:15:37,040 day, memory is not good, that sort of thing, then it could be a quality issue. 197 00:15:37,040 --> 00:15:41,120 And it's always changing. 198 00:15:41,120 --> 00:15:51,600 But right now, as of today, there are 34 separate sleep diagnoses. 199 00:15:51,600 --> 00:15:54,680 That's a lot. 200 00:15:54,680 --> 00:16:03,720 That does include, I think, eight that are specific to pediatrics. 201 00:16:03,720 --> 00:16:08,720 But I mean, 26 sleep diagnoses for adults, that's a lot. 202 00:16:08,720 --> 00:16:17,520 And there's quite a number of those that are common in adults, like restless leg syndrome, 203 00:16:17,520 --> 00:16:23,880 periodic movement disorder, that interfere with quality of sleep. 204 00:16:23,880 --> 00:16:33,880 So if we're talking just about maximizing sleep, particularly when you're not at work, 205 00:16:33,880 --> 00:16:36,520 then you have to consider these other things too. 206 00:16:36,520 --> 00:16:39,200 Yeah, that's right. 207 00:16:39,200 --> 00:16:42,600 You know, why you would want to go see a sleep specialist. 208 00:16:42,600 --> 00:16:45,920 Indeed, yeah, I didn't know that was going to be my next question. 209 00:16:45,920 --> 00:16:51,640 Let's talk about some sleep disorders, because it's not just all sleep apnea related. 210 00:16:51,640 --> 00:16:55,800 So I didn't know that there was that many, that's really, really interesting. 211 00:16:55,800 --> 00:17:00,520 Now if they're doing a general sleep study, are they going to be able to identify, or 212 00:17:00,520 --> 00:17:07,320 at least, hey, we want something happening, we want to further expand on those 26 adult 213 00:17:07,320 --> 00:17:08,320 sleep disorders? 214 00:17:08,320 --> 00:17:14,320 Or is that like a different sleep study each time to try to find those? 215 00:17:14,320 --> 00:17:17,360 That's a really good question. 216 00:17:17,360 --> 00:17:22,960 Sleep studies are really expensive when they're done in the lab. 217 00:17:22,960 --> 00:17:29,960 And so most insurance companies now won't even pay for an in-law sleep study unless you see 218 00:17:29,960 --> 00:17:32,680 a sleep specialist. 219 00:17:32,680 --> 00:17:34,920 Not all of them, but most of them. 220 00:17:34,920 --> 00:17:43,680 And there's good reason, because for a large number of sleep disorders, just talking to 221 00:17:43,680 --> 00:17:47,720 somebody, you can kind of figure out what the problem is. 222 00:17:47,720 --> 00:18:00,040 So just anecdotally, I had one patient that was brought in by his wife, and she was upset 223 00:18:00,040 --> 00:18:02,600 because of weird behaviors. 224 00:18:02,600 --> 00:18:08,240 And the thing that finally tipped them over was, is that she woke up in the middle of 225 00:18:08,240 --> 00:18:14,120 the night freezing and realized that there was a carton of ice cream sitting on her head. 226 00:18:14,120 --> 00:18:21,000 His sleep behavior was that he had nocturnal eating disorder, so he'd get up at night and 227 00:18:21,000 --> 00:18:26,320 get something to eat, but he was asleep when he was doing it. 228 00:18:26,320 --> 00:18:32,440 So this particular night, he got back in bed and eaten the ice cream and set the carton 229 00:18:32,440 --> 00:18:35,280 of ice cream on her head. 230 00:18:35,280 --> 00:18:38,360 And so we didn't need to put him in the sleep lab. 231 00:18:38,360 --> 00:18:43,080 It was like, oh, okay, I know what you have. 232 00:18:43,080 --> 00:18:46,000 So there's disorders like that. 233 00:18:46,000 --> 00:18:50,320 Same thing like with teeth grinding. 234 00:18:50,320 --> 00:18:56,480 That is a sleep diagnosis, sleep bruxism, teeth grinding. 235 00:18:56,480 --> 00:19:00,720 You talk to somebody, particularly if you have a bed partner, we always try to interview 236 00:19:00,720 --> 00:19:04,760 bed partners as best we can. 237 00:19:04,760 --> 00:19:09,800 You can make the diagnosis just from talking to somebody. 238 00:19:09,800 --> 00:19:14,200 There are times when we really do need to put somebody in the sleep lab and figure it 239 00:19:14,200 --> 00:19:15,200 out. 240 00:19:15,200 --> 00:19:20,880 Yeah, and it's funny as you're telling that story about ice cream or nocturnal sleep eating 241 00:19:20,880 --> 00:19:22,360 or what. 242 00:19:22,360 --> 00:19:27,240 We would call those in the fire service, those are called engineers, the guys and girls that 243 00:19:27,240 --> 00:19:29,920 drive the apparatus. 244 00:19:29,920 --> 00:19:32,160 They're known for having their midnight snacks. 245 00:19:32,160 --> 00:19:35,640 So we would call it the engineer disorder maybe. 246 00:19:35,640 --> 00:19:40,320 And to give some perspective, Dr. Petron's son is a firefighter in the fire service. 247 00:19:40,320 --> 00:19:46,920 And so he kind of understands the culture of what the fire side of this looks like, but 248 00:19:46,920 --> 00:19:53,080 then obviously working as a physician for many, many, many years, he understands the 249 00:19:53,080 --> 00:19:56,360 perspective of EMS and paramedics and things like that. 250 00:19:56,360 --> 00:19:59,040 So just wanted a quick little side note. 251 00:19:59,040 --> 00:20:02,440 But as always on the firefighter craftsmanship podcast, nothing that we're talking about 252 00:20:02,440 --> 00:20:05,200 here should be construed as medical advice. 253 00:20:05,200 --> 00:20:11,120 And so go talk to your primary care physician, do your own research, but talk to the experts 254 00:20:11,120 --> 00:20:16,520 and empower yourselves, take care of your own health journey is really, really important. 255 00:20:16,520 --> 00:20:20,160 So let's talk a little bit more about sleep deprivation. 256 00:20:20,160 --> 00:20:25,520 So can I be sleep deprived and not have a sleep disorder? 257 00:20:25,520 --> 00:20:28,960 I'm going to back up just a little bit. 258 00:20:28,960 --> 00:20:39,000 The sleep, just to me, is so darn fascinating because it's changing within society. 259 00:20:39,000 --> 00:20:49,560 So the American Academy of Sleep Medicine does these gigantic studies and issues, these 260 00:20:49,560 --> 00:21:00,560 papers that are very important because that's where the data comes for like CDC. 261 00:21:00,560 --> 00:21:09,160 And they showed that in the last, in 2015, when the study was completed, that more than 262 00:21:09,160 --> 00:21:16,800 70 million Americans were in the US, 70 million adults, I should say, were getting less than 263 00:21:16,800 --> 00:21:22,320 six hours of sleep per 24 hours on a regular basis. 264 00:21:22,320 --> 00:21:30,760 And that was up dramatically from the last big survey, which I think was done in 2002, 265 00:21:30,760 --> 00:21:32,360 maybe 2005. 266 00:21:32,360 --> 00:21:33,800 So it's increased. 267 00:21:33,800 --> 00:21:38,760 And because of this, it was a gigantic study. 268 00:21:38,760 --> 00:21:48,480 The CDC actually declared it public health epidemic because of sleep, they call it sleep 269 00:21:48,480 --> 00:21:50,880 restriction. 270 00:21:50,880 --> 00:22:00,520 So there's a difference between restricting your sleep because of societal issues. 271 00:22:00,520 --> 00:22:08,480 You've got work, you've got a family, you're going to athletic games for your kids. 272 00:22:08,480 --> 00:22:15,520 You're doing other things and that's restricting your sleep time. 273 00:22:15,520 --> 00:22:23,320 So that's why I say it's just sort of fascinating is that this is becoming more of a, almost 274 00:22:23,320 --> 00:22:26,160 more of a societal problem. 275 00:22:26,160 --> 00:22:30,000 Before it was shift work. 276 00:22:30,000 --> 00:22:35,840 And that shift work has been around for a long time in the US. 277 00:22:35,840 --> 00:22:43,600 But these other societal things, and a lot of it comes from screening time, as you might 278 00:22:43,600 --> 00:22:44,680 imagine. 279 00:22:44,680 --> 00:22:50,360 Screen time being bad for a lot of reasons because it's stimulating. 280 00:22:50,360 --> 00:22:56,240 They've sort of shown that it stimulates the pleasure part of the brain, these little 281 00:22:56,240 --> 00:22:57,760 video clips. 282 00:22:57,760 --> 00:23:04,480 And then of course, there's the light aspect, the blue light aspect, which is also affecting 283 00:23:04,480 --> 00:23:05,600 sleep. 284 00:23:05,600 --> 00:23:16,200 There is innumerable sleep deprivation studies done both in animals and humans that show 285 00:23:16,200 --> 00:23:30,920 this very, very strong association with cardiovascular risk, mental health issues, depression, weight 286 00:23:30,920 --> 00:23:38,080 gain because sleep deprivation alters the hormones responsible for appetite increases the hormone 287 00:23:38,080 --> 00:23:40,200 that makes us want to eat more. 288 00:23:40,200 --> 00:23:42,920 When we eat more, we don't eat the right calories. 289 00:23:42,920 --> 00:23:50,520 So that's associated with weight gain, associated with diabetes, cancer. 290 00:23:50,520 --> 00:23:57,680 There's some really alarming studies in that were done in night nurses that showed an increase 291 00:23:57,680 --> 00:24:04,480 in breast cancer and in ovarian cancer. 292 00:24:04,480 --> 00:24:12,200 And I've actually had discussions with my son about this because in the past, the fire 293 00:24:12,200 --> 00:24:20,080 service, they've clearly established they have higher incidence of cancer. 294 00:24:20,080 --> 00:24:28,360 But it's hard to sort out, is it because of exposure to carcinogens or is it because of 295 00:24:28,360 --> 00:24:31,200 sleep deprivation? 296 00:24:31,200 --> 00:24:40,320 And we know that sleep deprivation results in immune system dysfunction, which is probably 297 00:24:40,320 --> 00:24:44,200 why there's this increased risk for cancer. 298 00:24:44,200 --> 00:24:51,640 Talked about the cultural changes and cultural implications of sleep just for societal factors 299 00:24:51,640 --> 00:24:58,240 initially, and then the advent of technology and the technology companies, all the social 300 00:24:58,240 --> 00:25:04,920 media platforms, they're hiring the greatest minds in science because their trade is eyeballs. 301 00:25:04,920 --> 00:25:09,280 And so the longer that they can keep you on their platform, the more money that they make. 302 00:25:09,280 --> 00:25:15,520 And so it's really, really important for them to hire the best physiologists and psychologists 303 00:25:15,520 --> 00:25:20,360 and medical professionals to work for their companies to figure out how can we keep people 304 00:25:20,360 --> 00:25:25,120 on our platforms longer by targeting the dopamine receptors and things like that, the pleasure 305 00:25:25,120 --> 00:25:26,680 sides of the brain. 306 00:25:26,680 --> 00:25:29,200 And so really, really interesting correlation. 307 00:25:29,200 --> 00:25:35,320 But then you also talked about the busyness of life, regardless if you're on a 24-hour 308 00:25:35,320 --> 00:25:41,760 shift or you work a regular 40-hour week, you're still busy, busy, busy. 309 00:25:41,760 --> 00:25:43,880 Just societal has changed for sure. 310 00:25:43,880 --> 00:25:48,440 And then we stay up watching Netflix, Two Haters, whatever. 311 00:25:48,440 --> 00:25:51,520 Or areas of the country would be the same as well. 312 00:25:51,520 --> 00:25:56,600 So if you look at the East Coast, and then there's a Stanley Cup hockey game, but those 313 00:25:56,600 --> 00:26:01,560 teams are on the West Coast, well, the East Coast viewers are staying up a lot later than 314 00:26:01,560 --> 00:26:06,040 the West Coast viewers are for simple things like TV programming. 315 00:26:06,040 --> 00:26:09,000 So there's this massive thing of culture. 316 00:26:09,000 --> 00:26:13,920 And I think it's really important for us in emergency services to start having these conversations 317 00:26:13,920 --> 00:26:20,040 organizationally, especially because the decision makers typically are on a quote unquote 40-hour 318 00:26:20,040 --> 00:26:21,040 work week. 319 00:26:21,040 --> 00:26:24,640 They're working Monday through Friday, they're working days, they sleep in their own bed at 320 00:26:24,640 --> 00:26:26,400 night. 321 00:26:26,400 --> 00:26:28,520 But they are making decisions. 322 00:26:28,520 --> 00:26:32,080 And yes, a lot of those people are extremely overworked and they're choosing to work way 323 00:26:32,080 --> 00:26:33,600 more than 40 hours a week. 324 00:26:33,600 --> 00:26:35,520 That's not the debate that we're going to have. 325 00:26:35,520 --> 00:26:40,480 But they're making decisions for people that are an EMS where they might be working overnight. 326 00:26:40,480 --> 00:26:42,840 So working 12-hour shifts. 327 00:26:42,840 --> 00:26:47,000 But that decision maker is at home sleeping in their own bed every single night, seven 328 00:26:47,000 --> 00:26:48,760 days a week. 329 00:26:48,760 --> 00:26:51,640 And so same thing in the fire service, right? 330 00:26:51,640 --> 00:26:55,400 Where the heads of departments are making decisions, but they go home every single night and they 331 00:26:55,400 --> 00:26:57,240 sleep in their own beds. 332 00:26:57,240 --> 00:27:00,640 And the fire service is different than when they were online. 333 00:27:00,640 --> 00:27:04,200 It's just a matter of fact that every year, every department is getting busier and busier 334 00:27:04,200 --> 00:27:06,800 and busier because of cultural changes. 335 00:27:06,800 --> 00:27:08,560 The baby boomers are getting older. 336 00:27:08,560 --> 00:27:12,480 There's lots and lots of areas that we could expand to prove what we're kind of talking 337 00:27:12,480 --> 00:27:13,480 about. 338 00:27:13,480 --> 00:27:19,880 But I think it's a really, really important tangent to go down of culture impacts sleep. 339 00:27:19,880 --> 00:27:25,120 And so organizationally, we have cultures organizationally that we get to ebb and flow 340 00:27:25,120 --> 00:27:30,440 and drive positive or negative change within culture and sleep needs to be at the forefront 341 00:27:30,440 --> 00:27:31,640 of that. 342 00:27:31,640 --> 00:27:37,960 And then you tied it in perfectly of saying, hey, cardiac depression, mental health, which 343 00:27:37,960 --> 00:27:40,480 is tied to suicide, right? 344 00:27:40,480 --> 00:27:43,080 And cancer, the big one, cancer rates. 345 00:27:43,080 --> 00:27:49,040 And we're having in the fire service specifically, we know that not including cancer, 50% of our 346 00:27:49,040 --> 00:27:53,800 line of duty deaths every single year are cardiac related. 347 00:27:53,800 --> 00:27:58,040 So if sleep impacts cardiac health, we're doing things around fitness and the wellness 348 00:27:58,040 --> 00:28:01,520 fitness initiative and all these sorts of things. 349 00:28:01,520 --> 00:28:03,600 But there's very little chatter about sleep. 350 00:28:03,600 --> 00:28:07,240 There's nothing mentioned about sleep in most of these documents at all. 351 00:28:07,240 --> 00:28:09,040 And they're talking about cardiac health. 352 00:28:09,040 --> 00:28:15,600 And we can host literally hundreds of studies in relation to cardiac and sleep specifically. 353 00:28:15,600 --> 00:28:17,520 And now the big one is cancer. 354 00:28:17,520 --> 00:28:19,160 And so don't wear your gear. 355 00:28:19,160 --> 00:28:20,880 Don't put it in the cab. 356 00:28:20,880 --> 00:28:22,840 Make sure it's always clean. 357 00:28:22,840 --> 00:28:28,920 All this stuff and not a single mention about sleep. 358 00:28:28,920 --> 00:28:34,640 And it's just wrong for us to continue down this path and say, well, it's because your 359 00:28:34,640 --> 00:28:38,240 gear was dirty or the stuff that's burning is different. 360 00:28:38,240 --> 00:28:39,560 Yes, it's made out of plastic. 361 00:28:39,560 --> 00:28:42,480 We understand that it throws some nasty chemicals out there. 362 00:28:42,480 --> 00:28:46,080 But we're ignoring, it's not even an elephant in the room, right? 363 00:28:46,080 --> 00:28:52,440 It's like a whole entire herd of elephants that sleep creates immune system deficiency. 364 00:28:52,440 --> 00:28:56,880 Which is directly correlated to getting sick and directly correlated to fighting off things 365 00:28:56,880 --> 00:28:58,600 like cancer cells. 366 00:28:58,600 --> 00:29:04,920 I really applaud you for bringing this to the forefront and talking about it. 367 00:29:04,920 --> 00:29:10,640 Having been around for a long time, I've sort of seen how hard it is to make changes. 368 00:29:10,640 --> 00:29:13,320 Big example is school start times. 369 00:29:13,320 --> 00:29:19,760 We've known about the sleep physiology and the fact that a teenager, they want to go 370 00:29:19,760 --> 00:29:23,960 to bed later at night, get up later in the morning. 371 00:29:23,960 --> 00:29:29,120 But we were starting their school times early. 372 00:29:29,120 --> 00:29:38,520 And it took years and years and years of pounding this message into administrators before they 373 00:29:38,520 --> 00:29:40,400 actually changed to sleep times. 374 00:29:40,400 --> 00:29:47,960 And the data is overwhelming that it improved learning, decreased car accidents, all kinds 375 00:29:47,960 --> 00:29:48,960 of things. 376 00:29:48,960 --> 00:29:56,920 But what you brought up about hockey and it made me think about the fact that sleep is 377 00:29:56,920 --> 00:30:05,160 so important now that teams, professional teams, not just professional teams, but a lot 378 00:30:05,160 --> 00:30:16,280 of professional teams have a sleep medicine doctor on their roster and not roster in their 379 00:30:16,280 --> 00:30:29,200 organization to help with very specific scheduling issues to improve sleep because it affects 380 00:30:29,200 --> 00:30:33,520 performance, absolutely affects performance. 381 00:30:33,520 --> 00:30:38,920 And we're talking athletic performance, which it's not just athletic performance. 382 00:30:38,920 --> 00:30:43,840 It's also cognitive aspects too, because athletes have to think about what they're going to 383 00:30:43,840 --> 00:30:47,280 do so there's a cognitive aspect of them too. 384 00:30:47,280 --> 00:30:54,640 And I'm really worried about, I'm always worried about EMS folks, nurses that work by 385 00:30:54,640 --> 00:31:01,240 shift, that sort of thing and the effect on their daytime functioning. 386 00:31:01,240 --> 00:31:12,120 So the fact that you're stirring this up, bringing it up is super good because the solutions 387 00:31:12,120 --> 00:31:14,760 are out there. 388 00:31:14,760 --> 00:31:23,640 There are solutions and people may not like to hear about them, but there are solutions. 389 00:31:23,640 --> 00:31:34,480 And some of the things which really, really goes against the fire service is taking maps. 390 00:31:34,480 --> 00:31:43,960 Maps are unbelievably restorative and that again, the data is there that if you sleep 391 00:31:43,960 --> 00:31:50,200 deprived somebody and you compare them to somebody that you've given even to so much 392 00:31:50,200 --> 00:31:58,800 as a 20 minute nap to, the difference in performance is remarkable. 393 00:31:58,800 --> 00:32:01,760 So why don't we do this? 394 00:32:01,760 --> 00:32:10,680 Even the airlines who have been really reticent to do anything know that they have to give 395 00:32:10,680 --> 00:32:19,080 their pilots that are doing these transcontinental flights that are in the air for eight hours. 396 00:32:19,080 --> 00:32:25,560 They have to give them some time to lay down or rest or sleep or whatever, let the co-pilot 397 00:32:25,560 --> 00:32:28,200 take over and their performance is better. 398 00:32:28,200 --> 00:32:30,520 Their performance and alertness is better. 399 00:32:30,520 --> 00:32:32,120 It's simple. 400 00:32:32,120 --> 00:32:40,520 It's not hard stuff, but it goes against these cultures that have been ingrained in us. 401 00:32:40,520 --> 00:32:41,520 Yeah. 402 00:32:41,520 --> 00:32:45,760 Now, the big one is if I lay down and I take a nap, then I'm lazy. 403 00:32:45,760 --> 00:32:46,760 Right? 404 00:32:46,760 --> 00:32:47,760 Yep. 405 00:32:47,760 --> 00:32:48,760 Oh yeah. 406 00:32:48,760 --> 00:32:49,760 Of course. 407 00:32:49,760 --> 00:32:52,040 And I know nothing to do with lasers. 408 00:32:52,040 --> 00:32:53,040 Yeah. 409 00:32:53,040 --> 00:32:54,040 Not at all. 410 00:32:54,040 --> 00:32:56,120 I know some high performers that sleep a lot. 411 00:32:56,120 --> 00:33:00,760 I know some high performers for now at least that don't sleep very much. 412 00:33:00,760 --> 00:33:06,840 And I know some extremely lazy people that are not high performers that don't sleep at 413 00:33:06,840 --> 00:33:07,840 all. 414 00:33:07,840 --> 00:33:08,840 Right? 415 00:33:08,840 --> 00:33:10,960 They stay up really, really long or they sleep a bunch. 416 00:33:10,960 --> 00:33:11,960 Right? 417 00:33:11,960 --> 00:33:12,960 It has nothing to do with that. 418 00:33:12,960 --> 00:33:18,320 That's just that cultural tag of, well, that person's lazy or not a high performer. 419 00:33:18,320 --> 00:33:22,520 And I think you hit it right on the head is a lot of these solutions that are out there 420 00:33:22,520 --> 00:33:24,240 are actually free. 421 00:33:24,240 --> 00:33:26,840 They don't cost any money. 422 00:33:26,840 --> 00:33:30,440 And even if we look at it from a production standpoint, well, if they're sleeping, then 423 00:33:30,440 --> 00:33:35,400 they're not out there doing whatever, public education, inspections, like all these things, 424 00:33:35,400 --> 00:33:37,080 emergency services, training. 425 00:33:37,080 --> 00:33:38,400 Well, yeah. 426 00:33:38,400 --> 00:33:39,400 Okay. 427 00:33:39,400 --> 00:33:43,000 Would you rather have a person that took some downtime and now they go and they train and 428 00:33:43,000 --> 00:33:46,680 they actually process and learn the information? 429 00:33:46,680 --> 00:33:50,080 Or do they just show up to the training and they were up all night and now they try to 430 00:33:50,080 --> 00:33:56,120 survive until you are finally done blabbering or killing them by PowerPoint and they can 431 00:33:56,120 --> 00:34:01,720 go home or go back to now actually perform the job that we were tasked to do with if 432 00:34:01,720 --> 00:34:07,120 you're on a 48 hours sort of schedule and not remember anything that was just talked 433 00:34:07,120 --> 00:34:08,120 about. 434 00:34:08,120 --> 00:34:12,920 So production goes up when we have well rested members of our teams. 435 00:34:12,920 --> 00:34:20,800 There's a lot of data about that too, about memory and how important about, you can argue 436 00:34:20,800 --> 00:34:27,480 a lot about what the purpose of sleep is and just, you know, why do we sleep? 437 00:34:27,480 --> 00:34:29,280 That question always comes up. 438 00:34:29,280 --> 00:34:38,680 But for sure, one of the things that it does, it does is it takes our memories from short 439 00:34:38,680 --> 00:34:46,120 term and puts it into long term areas in the brain so that we can actually retain what 440 00:34:46,120 --> 00:34:49,000 we've learned. 441 00:34:49,000 --> 00:34:57,640 And when you do sleep restriction or sleep deprivation, whatever term you want to use, 442 00:34:57,640 --> 00:35:02,680 you know, it affects your ability to learn and memory during the day as well. 443 00:35:02,680 --> 00:35:08,640 So what is your suggestion for those of us that work a shift that isn't a 24 hour shift 444 00:35:08,640 --> 00:35:11,840 so let's say a police or EMS? 445 00:35:11,840 --> 00:35:14,600 We know that they should at least stick on those same shifts. 446 00:35:14,600 --> 00:35:17,800 So if you're working nights, you should stay nights and you see this a lot with physicians. 447 00:35:17,800 --> 00:35:22,880 I was just talking to a physician the other day where, you know, they take call or they're 448 00:35:22,880 --> 00:35:28,440 on rotation in the operating room and they might be working days and now they have to 449 00:35:28,440 --> 00:35:30,240 take call and now they're up all night. 450 00:35:30,240 --> 00:35:34,040 And yeah, they might have that next day off, but then now they're back at days and then 451 00:35:34,040 --> 00:35:35,480 they got to take call at night. 452 00:35:35,480 --> 00:35:40,200 And so they don't have like, and it's not like every Thursday they have call, right? 453 00:35:40,200 --> 00:35:41,720 It's on a rotational schedule. 454 00:35:41,720 --> 00:35:45,360 And so they don't have a lot of consistency either. 455 00:35:45,360 --> 00:35:51,560 And they're essentially working 24 hour shifts, but they're not in the fire service, you 456 00:35:51,560 --> 00:35:53,360 know, but they also work day shifts. 457 00:35:53,360 --> 00:35:57,960 So what are some suggestions like for police officers or some departments, you know, they 458 00:35:57,960 --> 00:36:01,720 try to share the load a little bit across the country and they say, all right, for now 459 00:36:01,720 --> 00:36:06,520 you're working days, and then you go to swing shifts and then you do nights and they're 460 00:36:06,520 --> 00:36:10,840 kind of sporadic and it's on a three month rotation or something like that. 461 00:36:10,840 --> 00:36:15,400 But isn't that actually worse for them than if they would just be have a night shift where 462 00:36:15,400 --> 00:36:18,720 they can create some consistency around those circadian rhythms? 463 00:36:18,720 --> 00:36:19,720 Sure. 464 00:36:19,720 --> 00:36:26,680 Ideally, you don't want to, you don't want to change your shift at all, but because 465 00:36:26,680 --> 00:36:31,640 there's a pay differential, you know, a lot of places there's a pay differential if you 466 00:36:31,640 --> 00:36:33,760 work night shift. 467 00:36:33,760 --> 00:36:44,160 And so there are ways to mitigate those effects, but there is also, so there's a couple principles. 468 00:36:44,160 --> 00:36:53,000 One is that you, if you're shifting your time, you want to always go forward, not backwards. 469 00:36:53,000 --> 00:37:03,920 So it's easier for us to go to bed later and get up later than it is to go to bed earlier. 470 00:37:03,920 --> 00:37:06,160 I mean, just try it. 471 00:37:06,160 --> 00:37:10,080 If you're on, you know, if you generally work your days, try to go to bed and go to sleep 472 00:37:10,080 --> 00:37:12,000 at six o'clock at night. 473 00:37:12,000 --> 00:37:14,760 It's this darn near impossible. 474 00:37:14,760 --> 00:37:21,560 But you can stay up and go to bed at three in the morning and fall right to sleep. 475 00:37:21,560 --> 00:37:23,680 Most likely you will fall right to sleep. 476 00:37:23,680 --> 00:37:28,040 So it's always easier if you're delaying your sleep. 477 00:37:28,040 --> 00:37:32,880 So that's, that's one principle that a lot of companies don't believe in. 478 00:37:32,880 --> 00:37:39,520 I don't know why I got into a really not a good situation with the company in Northern 479 00:37:39,520 --> 00:37:44,800 Colorado when I recommended that they quit going backwards. 480 00:37:44,800 --> 00:37:51,320 So making people go from nights to evenings to days, which is exactly the absolute long 481 00:37:51,320 --> 00:37:55,200 way to do it. 482 00:37:55,200 --> 00:37:57,080 But there's things like that. 483 00:37:57,080 --> 00:38:03,480 The other thing is that if you, it's really helpful if you understand what controls our 484 00:38:03,480 --> 00:38:04,480 sleep. 485 00:38:04,480 --> 00:38:13,360 So in the big picture, sleep is controlled by two things, circadian rhythm. 486 00:38:13,360 --> 00:38:19,680 And for humans, most mammals, not all, but for humans, your circadian rhythm is based 487 00:38:19,680 --> 00:38:25,800 on sleeping at dark and being awake during the light. 488 00:38:25,800 --> 00:38:30,440 And that's what entrains our sleep in this 24 hour cycle. 489 00:38:30,440 --> 00:38:39,080 The other thing that controls sleep is, well, the official name is the homeostatic function, 490 00:38:39,080 --> 00:38:42,680 but I always consider it the pressure to sleep. 491 00:38:42,680 --> 00:38:50,960 So the longer you're awake, the more pressure there is on your brain to sleep. 492 00:38:50,960 --> 00:38:57,680 So if you're up for 24 hours, the pressure to sleep is really great. 493 00:38:57,680 --> 00:39:02,080 And the only way to get rid of that is to sleep. 494 00:39:02,080 --> 00:39:06,400 The problem is, is if you start your day at seven in the morning, you go seven in the 495 00:39:06,400 --> 00:39:13,520 morning, the next day, then circadian rhythm kicks in and it wants to wake you up in the 496 00:39:13,520 --> 00:39:14,600 morning. 497 00:39:14,600 --> 00:39:22,680 So there's things you can do with light and napping at certain times and melatonin. 498 00:39:22,680 --> 00:39:27,040 It's a very complicated thing and you can actually really mess people up if you get 499 00:39:27,040 --> 00:39:34,880 the timing long, which is why a lot of these athletic teams hire a sleep physician or sleep 500 00:39:34,880 --> 00:39:38,880 PA or whatever to help them with their schedules. 501 00:39:38,880 --> 00:39:44,880 Specifically, let's just take, for example, an officer that's a police officer that goes 502 00:39:44,880 --> 00:39:50,480 on duty at five at night and gets off at five in the morning. 503 00:39:50,480 --> 00:39:57,920 The thing that they can do to help them sleep during the day is don't get exposed to bright 504 00:39:57,920 --> 00:39:59,160 light. 505 00:39:59,160 --> 00:40:03,200 So this is something I was always telling the night nurses to do. 506 00:40:03,200 --> 00:40:08,720 Put your dark glasses on before you walk out of the building and see sunlight. 507 00:40:08,720 --> 00:40:10,480 Really dark glasses. 508 00:40:10,480 --> 00:40:16,080 You wear your dark glasses till you get home and then you try to get into a dark room because 509 00:40:16,080 --> 00:40:19,760 light is so alerting to the brain. 510 00:40:19,760 --> 00:40:24,600 One of the things that entrains us, as I said, entrains asleep. 511 00:40:24,600 --> 00:40:30,800 So that's a really simple thing to do for people, but I've told people to do this many 512 00:40:30,800 --> 00:40:33,320 times in the past that and they don't do it. 513 00:40:33,320 --> 00:40:35,920 I don't know why, but it's very simple. 514 00:40:35,920 --> 00:40:42,320 And it's just by having the knowledge of what controls our sleep. 515 00:40:42,320 --> 00:40:48,280 And then you can use the pressure to sleep also as a positive to help you sleep because 516 00:40:48,280 --> 00:40:52,560 the longer you're up, the more you're going to want to sleep. 517 00:40:52,560 --> 00:41:00,960 But you have to go to a quiet, cool, dark place to sleep, not sleeping in your car in 518 00:41:00,960 --> 00:41:02,960 the sunlight. 519 00:41:02,960 --> 00:41:03,960 If that makes sense. 520 00:41:03,960 --> 00:41:04,960 Yeah. 521 00:41:04,960 --> 00:41:05,960 I mean, you can do that. 522 00:41:05,960 --> 00:41:09,000 If you're super sleepy, you'll fall asleep in your car in the sunlight. 523 00:41:09,000 --> 00:41:10,720 But that's not ideal. 524 00:41:10,720 --> 00:41:15,880 What you want to do is get several hours of sleep. 525 00:41:15,880 --> 00:41:22,360 And then the other technique, which is really, really important is taking a nap, no matter 526 00:41:22,360 --> 00:41:28,280 how brief it is before you go on one of these long stretches or a night shift. 527 00:41:28,280 --> 00:41:34,120 So if you know you're going to do 24 hours and you're going to be up for 24 hours, well, 528 00:41:34,120 --> 00:41:40,920 depending on when you start your shift may not be possible to do a nap, but taking the 529 00:41:40,920 --> 00:41:47,800 example of the officer that's going to be up from 5pm to 5am, if they take a nap in 530 00:41:47,800 --> 00:41:53,120 the afternoon right before their shift, that helps them stay more alert. 531 00:41:53,120 --> 00:42:01,400 So there's a lot of little things to do like that, not exercising right before you're going 532 00:42:01,400 --> 00:42:03,760 to sleep, that kind of thing. 533 00:42:03,760 --> 00:42:06,240 That's all considered sleep hygiene stuff. 534 00:42:06,240 --> 00:42:07,240 Yeah, fantastic. 535 00:42:07,240 --> 00:42:13,520 And a lot of that plays into biology and physiology and hormone release and all that 536 00:42:13,520 --> 00:42:14,520 stuff. 537 00:42:14,520 --> 00:42:19,880 So what kind of tricks do you have for, you know, in the fire service where we have no 538 00:42:19,880 --> 00:42:22,200 idea when the 911 call is going to come in. 539 00:42:22,200 --> 00:42:28,120 And so we, you know, we choose to go to work and we choose to respond to the best of our 540 00:42:28,120 --> 00:42:31,320 ability every time that we go to shift. 541 00:42:31,320 --> 00:42:34,960 But some people, you know, if they wake up 2, 3 in the morning, they have a really, really 542 00:42:34,960 --> 00:42:38,960 hard time falling back asleep. 543 00:42:38,960 --> 00:42:43,240 And they might toss and turn until they have to get up either for shift change or they 544 00:42:43,240 --> 00:42:47,840 got to get up for other organizational duties or they just get frustrated and they get up, 545 00:42:47,840 --> 00:42:50,080 let's say 6, 7 in the morning. 546 00:42:50,080 --> 00:42:55,800 So what kind of interventions or suggestions would you have for somebody like that that 547 00:42:55,800 --> 00:42:57,960 has a hard time falling back asleep? 548 00:42:57,960 --> 00:43:06,200 Yeah, that's a very difficult and surprisingly common problem because one of the things that 549 00:43:06,200 --> 00:43:15,320 happens as you well know, even if you've been in the fire service for a long time and you're 550 00:43:15,320 --> 00:43:20,880 used to getting these calls, it still causes an adrenaline rush. 551 00:43:20,880 --> 00:43:28,560 That adrenaline stays around for a while and it is highly stimulating and it's also very 552 00:43:28,560 --> 00:43:30,240 wake promoting. 553 00:43:30,240 --> 00:43:39,920 It's one of the dopamine and adrenaline and those are wake promoting neurotransmitters. 554 00:43:39,920 --> 00:43:47,920 So if you can't get yourself settled down in that setting, then it's really, it's hard 555 00:43:47,920 --> 00:43:54,520 to deal with because it's a neurochemical issue that's keeping you from falling asleep. 556 00:43:54,520 --> 00:44:01,080 The other big thing and we probably don't have time to really delve into this a lot, 557 00:44:01,080 --> 00:44:08,000 but it's a concept that I'd like people to think about because it's unbelievably important 558 00:44:08,000 --> 00:44:17,360 and it is the principle that drives treatment for insomnia and that is that we condition 559 00:44:17,360 --> 00:44:25,280 ourselves all the time and if you have trouble falling asleep in your bed and you lay there 560 00:44:25,280 --> 00:44:33,560 for 30 minutes, you only now what you've done is you negatively conditioned yourself even 561 00:44:33,560 --> 00:44:37,560 more to not be able to sleep there. 562 00:44:37,560 --> 00:44:46,520 So one of the principles which people do not like and will always fight with me about is 563 00:44:46,520 --> 00:44:52,840 if you're not sleeping in your bed, you have to get out of the bed and do something else 564 00:44:52,840 --> 00:45:00,480 because for whatever reason, that negative conditioning is super powerful and it will 565 00:45:00,480 --> 00:45:02,200 keep you awake. 566 00:45:02,200 --> 00:45:08,720 So you got to get up, you got to go somewhere else and do something not too stimulating 567 00:45:08,720 --> 00:45:13,920 like not going into the weight room and working out real hard and then trying to go back to 568 00:45:13,920 --> 00:45:14,920 sleep. 569 00:45:14,920 --> 00:45:15,920 That ain't got to work. 570 00:45:15,920 --> 00:45:16,920 It's a principle. 571 00:45:16,920 --> 00:45:17,920 Yeah. 572 00:45:17,920 --> 00:45:22,920 That's where the engineer nighttime feeding sesh usually happens, right? 573 00:45:22,920 --> 00:45:25,400 They go to the fridge when they get back from a call. 574 00:45:25,400 --> 00:45:31,080 Is that a good idea or not to eat when you're awake to eat half a gallon of ice cream and 575 00:45:31,080 --> 00:45:32,520 then try to go to sleep? 576 00:45:32,520 --> 00:45:38,600 Well, unfortunately, when you eat a meal, you get all kinds of, and it doesn't have to 577 00:45:38,600 --> 00:45:44,680 be a big meal, but if you eat very much, there's hormones that are released from the GI tract 578 00:45:44,680 --> 00:45:48,720 that are vaguely weight promoting. 579 00:45:48,720 --> 00:45:54,560 So maybe a couple of graham crackers and drink and some milk or something like that's okay, 580 00:45:54,560 --> 00:45:59,600 but fiction nachos and that sort of thing, probably not a good idea. 581 00:45:59,600 --> 00:46:05,480 The problem is, is like I said before, is that sleep deprivation increases the hormone 582 00:46:05,480 --> 00:46:11,800 that makes us want to eat more, increases that up to time. 583 00:46:11,800 --> 00:46:13,120 Why that affects engineers? 584 00:46:13,120 --> 00:46:17,560 I don't know, but that might explain a little bit of my son's eating habits. 585 00:46:17,560 --> 00:46:18,560 I don't know. 586 00:46:18,560 --> 00:46:19,560 There you go. 587 00:46:19,560 --> 00:46:23,120 That's why I'm picking on engineers because your son is an engineer. 588 00:46:23,120 --> 00:46:24,120 Yeah. 589 00:46:24,120 --> 00:46:25,240 That's great stuff. 590 00:46:25,240 --> 00:46:26,240 Can we talk real quick? 591 00:46:26,240 --> 00:46:27,240 We're almost out of time. 592 00:46:27,240 --> 00:46:32,280 I don't want to take too much of your time, but can we talk really quickly about alcohol? 593 00:46:32,280 --> 00:46:35,920 And obviously at work, we should not be drinking alcohol. 594 00:46:35,920 --> 00:46:40,560 And if you are, you need to definitely talk to a provider about that's not a great choice. 595 00:46:40,560 --> 00:46:47,400 So when our days are off and we hear a lot of people, oh, I have a couple drinks and 596 00:46:47,400 --> 00:46:50,160 it helps me fall asleep. 597 00:46:50,160 --> 00:46:54,840 Can you talk a little bit about the interaction of alcohol and what it actually does to our 598 00:46:54,840 --> 00:46:55,840 sleep? 599 00:46:55,840 --> 00:46:59,760 The alcohol, it does help people fall asleep. 600 00:46:59,760 --> 00:47:03,680 It does decrease the amount of time that it takes to fall asleep. 601 00:47:03,680 --> 00:47:12,160 The problem is, is that after everything is metabolized, the brain wakes up like three 602 00:47:12,160 --> 00:47:20,520 to four hours later and is more or less in a, I don't want to use the word agitated, 603 00:47:20,520 --> 00:47:24,960 but that's what it is, sort of an agitated state, a restless state. 604 00:47:24,960 --> 00:47:31,640 And so sure, you'll get two to three good hours of sleep, maybe four from alcohol. 605 00:47:31,640 --> 00:47:39,320 But then you pay the price the rest of the night and your overall quality is that good. 606 00:47:39,320 --> 00:47:45,000 What I've always told people, and I think that the physiology backs it up, is that you 607 00:47:45,000 --> 00:47:48,400 want to drink alcohol. 608 00:47:48,400 --> 00:47:54,080 You should try really hard to be done drinking your alcohol two hours before you go to sleep 609 00:47:54,080 --> 00:47:59,680 and make sure that you push fluence because alcohol dehydrates us. 610 00:47:59,680 --> 00:48:03,560 And that's another thing that tends to wake us up. 611 00:48:03,560 --> 00:48:13,720 I consider that a drug and most companies don't scream for alcohol unless you're visibly 612 00:48:13,720 --> 00:48:15,560 drunk on the chop or something. 613 00:48:15,560 --> 00:48:22,040 But yeah, lots and lots of medications back sleep. 614 00:48:22,040 --> 00:48:29,040 Yeah, and you notice that I never once said anything about using a drug to help us sleep 615 00:48:29,040 --> 00:48:32,160 because generally speaking, it's not anything. 616 00:48:32,160 --> 00:48:33,800 You gave us some great stuff here. 617 00:48:33,800 --> 00:48:35,160 I learned quite a bit. 618 00:48:35,160 --> 00:48:39,880 And I think one of the biggest ones is where you talked about the routine, especially for 619 00:48:39,880 --> 00:48:43,760 those of us, you may be that wake up and have a hard time falling back asleep. 620 00:48:43,760 --> 00:48:49,000 Well, the routine shouldn't include jumping on your cell phone and looking at social media 621 00:48:49,000 --> 00:48:52,200 or watching YouTube videos or whatever. 622 00:48:52,200 --> 00:48:57,200 That those things that are intentionally targeting the dopamine receptors, which helps 623 00:48:57,200 --> 00:48:58,880 us actually wake up. 624 00:48:58,880 --> 00:49:00,360 It's not going to help you fall asleep. 625 00:49:00,360 --> 00:49:03,960 So establish those routines. 626 00:49:03,960 --> 00:49:09,760 Some things I've tried to help coach people on is what's the routine before you go to 627 00:49:09,760 --> 00:49:10,760 sleep? 628 00:49:10,760 --> 00:49:12,840 Even if they're good about, hey, I plugged my phone in at home. 629 00:49:12,840 --> 00:49:13,840 It's in the bathroom. 630 00:49:13,840 --> 00:49:15,000 I don't have access to it. 631 00:49:15,000 --> 00:49:18,740 So I'm limiting my bed to a couple of things. 632 00:49:18,740 --> 00:49:20,000 So what are those routines? 633 00:49:20,000 --> 00:49:24,600 And then trying to replicate those at your place of work if you're in the fire service 634 00:49:24,600 --> 00:49:26,720 where you can sleep on duty. 635 00:49:26,720 --> 00:49:28,120 You brush your teeth. 636 00:49:28,120 --> 00:49:31,440 Place cold dark room, all those sorts of things. 637 00:49:31,440 --> 00:49:36,200 And then maybe trying to replicate some of those things when you come back from a call, 638 00:49:36,200 --> 00:49:37,200 right? 639 00:49:37,200 --> 00:49:41,440 Going in the bathroom, not turning all the lights on. 640 00:49:41,440 --> 00:49:45,360 Maybe all as far as brushing your teeth again, like cold water on your face or warm water 641 00:49:45,360 --> 00:49:49,320 on your hands and your face to cool down the inner temperatures, like all of those sorts 642 00:49:49,320 --> 00:49:53,640 of things that we're starting to learn more and more about, which is really, really cool. 643 00:49:53,640 --> 00:49:59,880 To establish those routines and try to keep them consistent from at home and at work. 644 00:49:59,880 --> 00:50:04,800 Or if you're traveling, like try to keep your routines consistent as much as possible. 645 00:50:04,800 --> 00:50:09,040 And your brain correlates, hey, I'm supine in a dark environment. 646 00:50:09,040 --> 00:50:10,040 It's comfy. 647 00:50:10,040 --> 00:50:12,080 I have the perfect pillow. 648 00:50:12,080 --> 00:50:14,520 It's time to go to sleep. 649 00:50:14,520 --> 00:50:15,920 Absolutely. 650 00:50:15,920 --> 00:50:19,240 Well, thank you, Dr. Petron. 651 00:50:19,240 --> 00:50:26,480 We really appreciate your knowledge and expertise on this and just a great, basic, easily to 652 00:50:26,480 --> 00:50:29,160 digest, easy to digest format for us. 653 00:50:29,160 --> 00:50:31,440 We really, really appreciate it. 654 00:50:31,440 --> 00:50:36,280 Lots of resources on sleep specifically at firefightercraftsmanship.com. 655 00:50:36,280 --> 00:50:37,680 And so head over there. 656 00:50:37,680 --> 00:50:44,080 And we also have this series of podcasts specifically that talks about all different types of sleep 657 00:50:44,080 --> 00:50:46,840 interventions or why sleep matters and things like that. 658 00:50:46,840 --> 00:50:49,600 How we can control the controllables. 659 00:50:49,600 --> 00:50:53,160 We're not trying to say we don't need to run 911 calls in the middle of the night like 660 00:50:53,160 --> 00:50:55,200 that thing exists. 661 00:50:55,200 --> 00:51:00,240 But how can we control around that, whether that's organizational cultures, personal cultures, 662 00:51:00,240 --> 00:51:04,760 even all the way down to gasp, what do our shifts actually look like? 663 00:51:04,760 --> 00:51:11,200 And maybe it's time to start looking at other options, things like the 2472 to allow people 664 00:51:11,200 --> 00:51:12,480 rest in recovery. 665 00:51:12,480 --> 00:51:17,000 So that when they come back to work, they're focused and they're happy, healthy and strong, 666 00:51:17,000 --> 00:51:19,240 both at work and off the job. 667 00:51:19,240 --> 00:51:21,880 So thank you again, Dr. Petron. 668 00:51:21,880 --> 00:51:22,880 Much appreciated. 669 00:51:22,880 --> 00:51:26,840 Thanks for listening to the firefightercraftsmanship podcast as always rate, review and follow 670 00:51:26,840 --> 00:51:27,840 the show. 671 00:51:27,840 --> 00:51:33,680 It helps us spread this using the algorithms to our advantage and share this as much as 672 00:51:33,680 --> 00:51:43,680 possible and stay smart.