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And you can listen to my conversation with John on episode 1011 of the Behind the Shield

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podcast.

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Welcome to the Behind the Shield podcast.

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As always, my name is James Gearing and this week it is my absolute honor to welcome back

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onto the show, Rachel Mockwald and Alison Breger.

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Now the reason why we're doing this special episode is I keep getting asked in the fire

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service, do you have research on shift work, the impacts of sleep deprivation on firefighters?

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And the answer is no, because to be completely blunt, no one has cared enough to do it until

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extremely recently.

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But what I do have is many episodes from members of the sporting community, members of the

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musculoskeletal injury community and the military.

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And you don't have to be a rocket scientist to see the parallels between our men and women

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in uniform in the armed services working under high stress and unusual work clocks and the

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first responder community.

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So we're going to take a deep dive into all things shift work, the detrimental impact

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on our cognition and performance, the disasters related to sleep deprivation, the chronic

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disease, the mental health, and also some solutions.

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Now before we get to this incredible conversation, as I say every week, please just take a moment

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to go to whichever app you listen to this on, subscribe to the show, leave feedback

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and leave a rating.

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Every single five star rating truly does elevate this podcast, therefore making it easier for

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others to find.

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And this is a free library of over 1000 episodes now.

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So all I ask in return is that you help share these incredible men and women stories so

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I can get them to every single person on planet earth who needs to hear them.

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So with that being said, I welcome back onto the show, Rachel Markwald and Allison Breger.

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Enjoy.

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Well, Rachel and Allison, I want to start by saying thank you so, so much for coming

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back onto the podcast.

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I've had each of you on individually.

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Allison, you were episode 177 and 513.

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Rachel you were 196.

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So for people listening, if you want to hear the whole deep dive, then go to those.

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But you are my kind of gurus when it comes to sleep medicine and performance in the military

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specifically.

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So I just want to say thank you so much for joining us today.

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Snow clanging barbells in the back.

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I think the last time I spoke there was I was at the gym or something and there was

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music and barbells.

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Yeah, yeah, I think so.

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I've had some pretty interesting background noises in the thousand plus episodes.

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So let's start.

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We're just going to go with backgrounds just to kind of, you know, recap so people know

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who you guys are and your kind of history.

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So Rachel, let's start with you.

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Just give me your background as far as, you know, the research side and the military side.

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Yeah, my background sports medicine, exercise, physiology.

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Yeah, then learned about this entire other field called sleep.

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And given that I had my own personal sleep difficulties and I also as being an athlete

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understood the sort of inherent importance of sleep, it felt really natural for me to

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move into that space and feel those pretty excited to to step into sleep and performance

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as a field.

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And then, yeah, after my PhD and a postdoc, I started working with the Navy and have been

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working at Naval Health Research Center, which is part of Navy Medicine Research and Development

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Enterprise for going on 14 years.

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Beautiful.

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Yeah, it's a lot of what I'm doing is with, you know, sailors on ships, not just sailors

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on ships, though.

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I mean, we're working with the Marine Corps as well.

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And we just kind of go where we need to go, where the stated needs and gaps are.

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And often we're trying to envision like how we can take technology solutions from the

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commercial side, you know, over to the military and be put to use in a way that makes sense

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and actually helps solve or at least address stated issues.

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Right.

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Wearables technologies are a big part of what we do.

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So I'll leave it there.

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Yeah.

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All right.

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Well, I'm kind of, as I always tell people, the Army to Rachel's Navy and coincidentally,

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a lot of people think we're like twins because a lot of times we'll go to sleep conferences

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and people are like, oh, I just saw you.

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I was like, no, you probably saw Rachel.

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Similar to Rachel.

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So I started out in sleep physiology, not exercise physiology, but I too, as an athlete,

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always viewed sleep as my secret weapon when I was competing in college and then trying

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to make the Olympic team in 2008 unsuccessfully.

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And so I, same as Rachel, just sort of kept with that path, went on, did graduate school,

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circadian physiology lab, went on to do a postdoc and a sleep physiology lab, which

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brought me to a second postdoc at Walter Reed, ended up direct commissioning there into the

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Army.

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And so similar to Rachel, I support the needs of the Army from the perspective of sleep.

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So how do we optimize sleep under limited sleep opportunities in far forward environments?

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So staying with you, Alison, let's start with the Army first.

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When you kind of obviously joined this department, what was the history of this conversation

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with sleep?

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Because obviously I think this whole topic is somewhat new, which is why I got to give

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grace to members of the fire service and law enforcement.

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There are people that just don't know.

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There are a lot of people that have figured it out and do know, and some of them are refusing

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to acknowledge it.

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But there are a lot of us, myself included, that it took quite deep into my career to

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even the penny to drop and go, oh, we need to sleep.

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So when you look at the Army specifically, how far back did it go where people started

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looking at that area specifically?

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So I commissioned in 2016.

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And I still think it depends on the unit, right?

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Where I work now, sleep is not seen as a crutch.

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It's seen as the competitive edge and overmatch.

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But at least in 2016, the only reason and way people cared about sleep, and I hate to

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say this, is because soldiers died.

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One of the first projects we worked on was because there was a fatigue-related accident

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where at least four people died.

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So it's different now because we have the whole holistic health curriculum.

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But even with that, it's commander dependent.

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And there are still commands and units out there where they don't take it seriously,

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and then someone dies and they're forced to take it seriously.

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Not to be grim, but I think that's the current state of what I see in the Army.

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What is the difference between the leadership that's proactive and the people who still

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have their head in the sand?

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Well, one thing is productivity and actual good leadership, right?

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The commanders who are being proactive, they're in general just good leaders all around, physically

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fit, cognitively fit, emotionally fit.

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And they're always looking out for their soldiers, but also themselves.

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They fully recognize that being a commander is certainly not easy.

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I can tell you having finished company command just two years ago is sleep is the only way

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to perform at your best during those times.

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And that to me, I think is the defining difference coupled with people who don't embrace sleep

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tend to suffer from what I've noticed, what I like to call cognitive dissonance.

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And that they think they're high performing, but if you interview members of their unit,

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which is part of what we do in some of our sleep health studies, you actually find out

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that their culture of their unit absolutely sucks.

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But it's not a surprise because as the late godfather of military sleep medicine, Dr.

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William C. DeMette used to say, sleepiness makes you stupid.

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So that's my opinion.

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Absolutely.

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But one more for Alison, before we go back to Rachel.

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One of the ironies is if you look at sleep deprivation, for sleep deprivation, which

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arguably actually parallels a lot of the fire service, we find it in special forces selection.

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We find it interrogation and torture sometimes.

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So talk to me about the deliberate sleep deprivation to break down candidates, whether it's to

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get them to quit, to find the toughest soldier or something else.

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Because I think it's important for people to understand that we deliberately sleep deprived

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to force a negative reaction, which when understood makes you realize how important sleep is for

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performance.

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Yeah.

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So that's what we do too, right?

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Without getting too much into the details.

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We need to do that because we need to find out who performs under stress.

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And we usually find, we know this because we spent 15 years essentially doing this,

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and human and animal models is there's a whole genetic component to resiliency and tolerance

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to sleep deprivation.

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And to me, selection is finding who has good genetics, who can actually tolerate the stress

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and the demands of sleep deprivation and perform relatively okay under those demands on a daily

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basis.

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But after selection, you can't train for sleep deprivation and then get conditioned to it

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and then be in a far forward environment.

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You need sleep, but you do need to find those people initially who can tolerate sleep, which

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again is less under their volitional control than they think.

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It's genetically and biologically regulated.

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Absolutely.

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I think that's the misunderstanding that there's a short period where you're depriving people

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in selection, for example, but then after that, it completely flips the other way where

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you're using sleep as a superpower now.

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In the fire service, it's like hell week goes on for 20, 25 years, which I don't think they

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quite understand.

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That's not very good for you.

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Yeah.

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Same here.

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Yep.

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All right.

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Well, Rachel, let's go again to the kind of origin of the sleep discussion in the Navy.

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Yeah.

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I mean, I think sleep and fatigue risk management has been nestled up under sustained operations

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research for a number of decades, right?

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We weren't really calling it sleep research, just sleep research, and we're calling it

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like endurance research.

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But it really started, I think, to take shape more as the public domain, like the awareness

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within the public domain increased.

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When I stepped into initially a contract role with NHRC in 2011, there was no one here really

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doing sleep.

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So it was really just, I mean, there are researchers in the DOD who were focused on sleep as a

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contributing variable to health and performance, but there wasn't a dedicated sleep team or

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laboratory or group that was really solely focused on how do we improve sleep, how do

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we optimize sleep for better performance.

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So since then, 2011, our team and our group at NHRC has grown substantially.

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The work has grown substantially.

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But I hate to say this, and it echoes what Alison already said, which is there is a big

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growth happening after, unfortunately, there were two collisions at sea, which we discussed

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last time when I was on the podcast.

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There's been a number of these safety sort of relevant or related incidents that have

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occurred since then.

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So it's still a problem.

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It's so much so that the Government Accountability Office continues to hold the Navy's hand

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to the fire here.

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What are you doing to address fatigue?

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And to the credit of surface forces, they're doing quite a lot, and we're doing our best

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to support them.

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But at the end of the day, there's more work that needs to be done than sailors who can

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do it when we're talking about sailors on ships.

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And so there's root causes at play, and I think we're all sort of well, we sort of know

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now what those root causes are.

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It's not really up for debate anymore.

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But how you manage the risk that is presented.

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And you talked about using sleep and sleep deprivation to basically screen people, right?

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Initially, how do they respond under stress?

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And we need people who are capable of responding well under stress.

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But when you continue to sustain that level, as you were just mentioning, James, how we

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continued, when you have this accumulated sleep debt with no result, there's a level

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of risk that just continues to sort of accrue over time.

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What is that risk, actually?

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That's a research question we're looking to help understand more about.

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But questions like how much recovery is necessary?

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If you're an institute a day or two here and there on a deployment, for instance, of many

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months in length, how far does that one or two, whatever it is, days get you in terms

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of protecting their performance and readiness?

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So those are the questions we're answering now.

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Unfortunately, root causes are the root causes.

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And there's a more focused and intentional effort at getting after how to manage sleep,

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how to manage fatigue.

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But yeah, that's kind of where we're at.

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It takes, unfortunately, a couple, it really takes catastrophic consequences to drive action

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often and this is no different, of course.

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We discussed in the past, but I'd love to revisit because one of the resistances to

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making change and we'll get into the recruitment crisis, but we're so understaffed now.

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We've got these poor men and women that are already working 56 hour weeks, 24 hours at

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a time.

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And now they're being told at 7 a.m. you can't go home, you've got to stay for another 24.

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So that's 48 hours now without sleep, 80 hours a week.

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And so we're at a crisis.

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We're absolutely at a crisis.

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And so the answer is to invest in the fire service, fix the things that are broken, which

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will attract the young people back and fill all these spaces.

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Oh God, I just totally lost my train of thought.

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I go, oh, that's right.

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So one of the pushbacks is the financial side.

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Well, just if you look at the overtime at the moment, there's literally probably enough

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money in most cities and counties just in that.

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So if you invested in that extra shift, make that overtime go away, then you'll be saving

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money year after year after year.

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One of the other areas, though, that people don't think about is the mistakes that we

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make that you see intersection crashes with fire trucks and police cars and those kind

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of things.

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You hear about us pushing the wrong medication or simply just getting rough with a patient

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that resolves in a lawsuit.

272
00:18:31,160 --> 00:18:38,360
So let's revisit some of the disasters and what were the financial costs of those disasters?

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Well, let's take in a major worship off the line.

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Wow.

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That's a direct impact to readiness.

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So in terms of a number, I mean, that's millions of dollars in damage, right?

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That has to be fixed.

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But again, the real threat is just taking the ship off the line.

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So that from a purely monetary or financial or cost perspective, yeah, millions of dollars,

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but the real issue there is just that readiness factor.

281
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Like even savings, it was the same thing with the army too.

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I mean, aircrafts, right?

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Not cheap.

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And the other factor too, you know, Rachel and I have talked about this before is reductions

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in risk for injury, which lead to reductions in healthcare costs.

286
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I know that's one of the pitches now.

287
00:19:42,680 --> 00:19:50,460
Again, it relates back to readiness is when you give people these opportunities to sleep

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and recover, they go to the doctor less, their healthcare premiums are less.

289
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And the company is ultimately saving on healthcare costs for its people because their people

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are healthier.

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So it's those things that I think really need to be, those are the data that need to be

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collected in order to convince command teams to make policy changes around sleep.

293
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Yeah, and I'll add that prevention is challenging.

294
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I mean, we're talking prevention here and if nothing happens, that's a good thing, right?

295
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So the absence of continued incidents, errors, accidents is a good thing.

296
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And how to quantify that is a struggle in order to provide the evidence that's necessary

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to drive action.

298
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And prevention is just tricky, but yes, everything Alison said, yeah.

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Well, as you mentioned, I mean, when it comes to workman's comp, we'll dive into the chronic

300
00:20:56,440 --> 00:21:00,200
disease and the mental health issues of sleep deprivation in a minute, but let's stay on

301
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injury.

302
00:21:01,200 --> 00:21:05,920
What have you seen as far as studies between the correlation of sleep deprivation and the

303
00:21:05,920 --> 00:21:08,400
increase in probability of injury?

304
00:21:08,400 --> 00:21:13,200
Alison, you want to take it?

305
00:21:13,200 --> 00:21:15,000
Yeah, sure.

306
00:21:15,000 --> 00:21:24,320
So we over the years have done this sort of field-based analysis where we correlate ActiWatch

307
00:21:24,320 --> 00:21:25,320
data.

308
00:21:25,320 --> 00:21:31,920
So long lived the ActiWatch, but it was the clinical grade form of collecting sleep and

309
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activity levels to sort of inform total sleep time, sleep staging across 24-hour period.

310
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They're super durable.

311
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We've taken them all over the world to include Antarctica.

312
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We've taken them overseas to active combat war zones.

313
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And anytime we do any sort of these correlation analyses where we're looking at total sleep

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time in a 24-hour period with some metric, whether it's a performance metric like marksmanship

315
00:22:04,720 --> 00:22:13,560
or a performance metric like injury risk or a subjective metric like energy and mood states,

316
00:22:13,560 --> 00:22:18,320
there seems to be, and it doesn't matter what the mission set is, what the unit is, what

317
00:22:18,320 --> 00:22:21,040
their military tasks are.

318
00:22:21,040 --> 00:22:29,120
There's this really nice exponential relationship between total sleep time and risk for injury

319
00:22:29,120 --> 00:22:36,400
or decrements in performance in that if you are getting close to eight hours of sleep,

320
00:22:36,400 --> 00:22:42,560
your performance and your risk factor is essentially close to zero.

321
00:22:42,560 --> 00:22:49,280
But as soon as you get six hours of sleep, then you immediately have a 50-50 chance of

322
00:22:49,280 --> 00:22:57,360
either hitting the target or not hitting the target or a 50% chance of sustaining an injury.

323
00:22:57,360 --> 00:23:02,600
And then when you get down to four hours of sleep over a consistent period of time, you're

324
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looking at about an 80% likelihood of error.

325
00:23:06,840 --> 00:23:12,840
So that's really, I mean, in a broad strokes what we're seeing on the army side, but I'll

326
00:23:12,840 --> 00:23:14,440
let Rachel chime in.

327
00:23:14,440 --> 00:23:15,440
Yeah.

328
00:23:15,440 --> 00:23:21,360
And I mean, currently the type of research we're doing, we're not necessarily gathering

329
00:23:21,360 --> 00:23:23,400
those performance metrics right now.

330
00:23:23,400 --> 00:23:30,400
We're doing a whole lot of trying to best discern sleep in operational environments

331
00:23:30,400 --> 00:23:35,120
with the next stages, you know, because we have a lot of laboratory research and kind

332
00:23:35,120 --> 00:23:39,960
of what Alison just mentioned is, you know, relevant to what we see with lab research

333
00:23:39,960 --> 00:23:44,280
on our side, like a shooting simulator and things like that.

334
00:23:44,280 --> 00:23:49,480
But when it comes to actually doing some of this research out in the field, one of the

335
00:23:49,480 --> 00:23:56,960
limiting factors is the scalability of being able to include people in studies and having

336
00:23:56,960 --> 00:24:00,200
these new tools that are potentially available.

337
00:24:00,200 --> 00:24:06,080
I say, like in quotes, these wearable type commercial devices like Fitbit, Garmin, WOOP,

338
00:24:06,080 --> 00:24:11,200
Aura, they offer a better understanding at least.

339
00:24:11,200 --> 00:24:16,040
And again, with the caveat of not everything is going to be accurate on these devices,

340
00:24:16,040 --> 00:24:19,880
but they can help us understand and characterize sleep and scale.

341
00:24:19,880 --> 00:24:22,840
So we're trying to do that ship level at this point.

342
00:24:22,840 --> 00:24:28,080
So we've moved from like small research studies to large, you know, hundreds to even thousands

343
00:24:28,080 --> 00:24:30,020
of people at the same time.

344
00:24:30,020 --> 00:24:35,160
So we can gather quick insights on their sleep parameters and understand how something like

345
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total sleep time in their natural operating environment under high stress conditions at

346
00:24:41,560 --> 00:24:48,720
times or sleep quality as we're really looking at like a function of how much are they sleeping

347
00:24:48,720 --> 00:24:54,360
relative to the time of opportunity that they had to sleep can impact their self-report.

348
00:24:54,360 --> 00:24:57,760
So at this point, we're asking a lot of questions on how fatigued you feel.

349
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Do you feel like your fatigue is impacting the safety of yourself and others?

350
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So questions like that.

351
00:25:05,240 --> 00:25:16,160
And absolutely, people are very, very forthcoming about the fact that they experience fatigue

352
00:25:16,160 --> 00:25:21,680
and that fatigue, they're more likely to identify it as being a problem in someone else than

353
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themselves.

354
00:25:22,680 --> 00:25:28,160
And I think this speaks to Allison's point earlier about you almost become out of touch

355
00:25:28,160 --> 00:25:31,800
with sort of where you're at in your performance readiness.

356
00:25:31,800 --> 00:25:37,540
And I don't want to say adapt, because that's not the right term, but you almost calibrate

357
00:25:37,540 --> 00:25:43,160
to the feelings of fatigue and don't recognize that it's impacting your performance.

358
00:25:43,160 --> 00:25:45,960
And so we see that in our data, right?

359
00:25:45,960 --> 00:25:51,440
And their willingness to say, yeah, so and so is, you know, potentially experienced fatigue.

360
00:25:51,440 --> 00:25:53,720
That's problematic, but not me.

361
00:25:53,720 --> 00:25:57,620
I think even when it comes to the mental health conversations, one of the biggest problems

362
00:25:57,620 --> 00:26:02,720
is you take a fire station, you know, a crew that's working on that particular shift, they

363
00:26:02,720 --> 00:26:07,600
all seem fine because their barometer is a baseline is completely skewed.

364
00:26:07,600 --> 00:26:11,880
So I always tell people, ask your family, ask someone who hasn't seen you for a week,

365
00:26:11,880 --> 00:26:12,880
how are you doing?

366
00:26:12,880 --> 00:26:16,200
Because your engineer and your captain, you're fine, because they're just as tired as you

367
00:26:16,200 --> 00:26:17,200
are.

368
00:26:17,200 --> 00:26:18,200
Yep.

369
00:26:18,200 --> 00:26:19,200
Yeah, more tired.

370
00:26:19,200 --> 00:26:21,600
Yeah, absolutely.

371
00:26:21,600 --> 00:26:26,920
Well, staying on that, what about critical thinking?

372
00:26:26,920 --> 00:26:30,800
Have you done, have there been any studies on the impact of C deprivation on making good

373
00:26:30,800 --> 00:26:31,800
decisions?

374
00:26:31,800 --> 00:26:36,400
Because whether it's a teenager reaching for their driving license and you've got a sleep-deprived

375
00:26:36,400 --> 00:26:41,680
police officer, or whether it's a paramedic trying to figure out pediatric cardiac algorithms

376
00:26:41,680 --> 00:26:47,640
at three in the morning, the decisions that we're required to make, I would argue, you

377
00:26:47,640 --> 00:26:51,840
know, should require as much rest and recovery as possible.

378
00:26:51,840 --> 00:26:56,320
But with this understaffed, overworked environment that we're in, we're asking people to make

379
00:26:56,320 --> 00:27:00,520
these critical decisions woefully sleep deprived.

380
00:27:00,520 --> 00:27:09,000
Yeah, so I mean, that's actually a classic study from our, I guess Rachel is part of

381
00:27:09,000 --> 00:27:15,560
this academic pedigree to the, I call him the godfather of military sleep medicine research,

382
00:27:15,560 --> 00:27:16,560
Tom Balkan.

383
00:27:16,560 --> 00:27:24,840
He really has set the standard and has created the landscape and has given a platform for

384
00:27:24,840 --> 00:27:26,520
military sleep research.

385
00:27:26,520 --> 00:27:35,480
But he did a study a few years ago with another active duty uniform sleep scientist, Colonel

386
00:27:35,480 --> 00:27:41,660
Scott Kilgore, when they were both at Walter Reed, where they looked at ethical decision

387
00:27:41,660 --> 00:27:48,280
making under both chronic sleep loss, so, you know, five hours of sleep and a seven-day

388
00:27:48,280 --> 00:27:51,800
period as well as acute sleep deprivation.

389
00:27:51,800 --> 00:27:59,640
And one of the things they found was that as the course of sleep deprivation went on,

390
00:27:59,640 --> 00:28:10,020
the individuals tended to diminish the, or not consider the severity of ethical violations

391
00:28:10,020 --> 00:28:21,760
to be as great or as severe and would oftentimes justify why this person in this scenario should

392
00:28:21,760 --> 00:28:31,480
make this unethical, otherwise unethical decision because of sleep deprivation.

393
00:28:31,480 --> 00:28:38,360
So I mean, essentially what we like to say is that sleep deprivation hijacks the, you

394
00:28:38,360 --> 00:28:44,680
know, emotional and decision making centers of the brain to create, again, what Rachel

395
00:28:44,680 --> 00:28:47,880
was talking about, this idea of cognitive dissonance that you don't think you're sleep

396
00:28:47,880 --> 00:28:54,360
deprived, you think other people are, but not you, you know, sleepiness makes you stupid.

397
00:28:54,360 --> 00:28:57,840
Yeah, I mean, well said.

398
00:28:57,840 --> 00:29:00,200
I don't really have anything more to offer there.

399
00:29:00,200 --> 00:29:01,200
That's on point.

400
00:29:01,200 --> 00:29:05,600
Well, Rachel, seeing as you brought it up a second ago, I just want to dive into this

401
00:29:05,600 --> 00:29:06,600
a little bit more.

402
00:29:06,600 --> 00:29:13,040
I had a Professor Russell Foster on about two years ago now and he was the father of

403
00:29:13,040 --> 00:29:18,400
circadian rhythms really just because he discovered the chronoreceptor in the eye and he was laughed

404
00:29:18,400 --> 00:29:23,160
at by the ophthalmologists, I believe it was, his rods and cones and that was it.

405
00:29:23,160 --> 00:29:25,880
You know, how dare you insult us by bringing this?

406
00:29:25,880 --> 00:29:27,240
And then he proved it.

407
00:29:27,240 --> 00:29:30,120
And then we realized now that, yeah, this is where you hear all this get up and stare

408
00:29:30,120 --> 00:29:34,200
at the sun, you know, I don't hear him credited for that very often, but you know, I would

409
00:29:34,200 --> 00:29:37,680
argue he's also one of the grandfathers of this research.

410
00:29:37,680 --> 00:29:43,280
In this conversation, we were talking about wearables and he was talking about where the

411
00:29:43,280 --> 00:29:48,280
science is solid, but where also made this a misleading advertising when it comes to

412
00:29:48,280 --> 00:29:49,280
them.

413
00:29:49,280 --> 00:29:50,280
So talk to me about that.

414
00:29:50,280 --> 00:29:51,280
Yeah, yeah.

415
00:29:51,280 --> 00:29:56,680
Happy to talk about this topic.

416
00:29:56,680 --> 00:30:05,520
So the commercial devices, again, Fitbit, Wub, Garmin, Oaring type devices, they are

417
00:30:05,520 --> 00:30:12,760
estimating sleep and wake, you know, and sleep stages based off of peripheral information

418
00:30:12,760 --> 00:30:16,200
that they're measuring from, say, like the level of the finger or the level from the

419
00:30:16,200 --> 00:30:17,920
wrist or arm.

420
00:30:17,920 --> 00:30:23,460
They're not directly measuring the brain activity that we use to define sleep stages.

421
00:30:23,460 --> 00:30:30,560
So over the, you know, we've been doing wearables, commercial or consumer wearables, evaluation

422
00:30:30,560 --> 00:30:33,880
studies for years now and have several publications on this.

423
00:30:33,880 --> 00:30:40,760
And as we've seen the technology advance, new bottles come out, we do see that they're

424
00:30:40,760 --> 00:30:42,400
doing a better and better job.

425
00:30:42,400 --> 00:30:46,400
Some of them, with the caveat there, some of them are doing a better and better job

426
00:30:46,400 --> 00:30:50,360
at estimating sleep stages, but they're still far off from like being able to use them in

427
00:30:50,360 --> 00:30:54,360
a clinical sense by any means, shape, form.

428
00:30:54,360 --> 00:31:02,080
But what they can do, and this is where the field is separated, right, is some of them

429
00:31:02,080 --> 00:31:11,520
can be used to get sleep, like summary data, what we would call total sleep time, time

430
00:31:11,520 --> 00:31:19,160
in bed, time awake, you know, the timing of the overall sleep period itself.

431
00:31:19,160 --> 00:31:25,440
Some can do those metrics fairly well, even in irregular sleep.

432
00:31:25,440 --> 00:31:33,480
Now why that's important is because irregular sleep is challenging to the algorithms that

433
00:31:33,480 --> 00:31:38,800
are intended for the consumer market, who by and large are going to be night sleepers,

434
00:31:38,800 --> 00:31:41,520
which we're diurnal, right, we normally sleep at night.

435
00:31:41,520 --> 00:31:48,440
There are many reasons why the consumer devices would be engineered and tuned to nighttime

436
00:31:48,440 --> 00:31:49,760
sleep.

437
00:31:49,760 --> 00:31:52,360
And so that's not our world.

438
00:31:52,360 --> 00:31:56,560
That's not military, that's not fire, right.

439
00:31:56,560 --> 00:32:02,360
You need a device that can actually pick up irregular or daytime sleep.

440
00:32:02,360 --> 00:32:07,440
The timing of sleep is from a day to day standpoint is all over the place, maybe short naps here

441
00:32:07,440 --> 00:32:11,280
and there, those types of conditions.

442
00:32:11,280 --> 00:32:14,160
And some can do it very poorly.

443
00:32:14,160 --> 00:32:18,640
It's just really don't want to base anything on those devices, so it's really important

444
00:32:18,640 --> 00:32:23,120
to look to the research to see which ones have been evaluated.

445
00:32:23,120 --> 00:32:27,920
And there is no perfect commercial wearable device.

446
00:32:27,920 --> 00:32:31,560
There is nothing that's going to give you the 100% truth.

447
00:32:31,560 --> 00:32:34,920
And that just needs to be understood right out of the gates.

448
00:32:34,920 --> 00:32:40,120
They shouldn't really be relied on on a night to night basis, but they're good over time

449
00:32:40,120 --> 00:32:46,080
to help us understand our patterns and then also how our behaviors may impact our patterns.

450
00:32:46,080 --> 00:32:52,560
Now that all being said, we can use information from devices potentially, and we're doing

451
00:32:52,560 --> 00:33:01,080
this with some work we're doing with the Navy to help relate risks up the chain of command

452
00:33:01,080 --> 00:33:06,280
so that we understand that there are people who may have fall through the cracks, who

453
00:33:06,280 --> 00:33:13,560
may not be known because missions change suddenly, there's all kinds of unexpected events that

454
00:33:13,560 --> 00:33:15,000
can occur.

455
00:33:15,000 --> 00:33:21,160
And particular people, let's say engineers on a ship, you have some kind of casualties,

456
00:33:21,160 --> 00:33:26,000
so what it means is like an equipment failure, so you need an engineer to get in there and

457
00:33:26,000 --> 00:33:27,000
fix it.

458
00:33:27,000 --> 00:33:28,000
That takes time.

459
00:33:28,000 --> 00:33:29,960
Now they've missed their sleep period, right?

460
00:33:29,960 --> 00:33:33,200
And now they're going on watch, and now they've got other stuff to do.

461
00:33:33,200 --> 00:33:37,240
And now it's suddenly been over 24 hours, maybe 30 hours since that particular individual

462
00:33:37,240 --> 00:33:38,240
slept.

463
00:33:38,240 --> 00:33:44,520
And now the ship is going into some kind of inspection or at sea replenishment or some

464
00:33:44,520 --> 00:33:48,000
kind of event that would then make everybody need to stay up.

465
00:33:48,000 --> 00:33:54,120
And so that particular person is not being tracked or noticed or understood necessarily

466
00:33:54,120 --> 00:33:59,160
what's going on with them, especially if that person is in a safety critical billet, what

467
00:33:59,160 --> 00:34:05,400
we call safety critical billets, that could result in considerable risk, right?

468
00:34:05,400 --> 00:34:09,920
So we think that wearables can be used for those types of extreme cases to say, hey,

469
00:34:09,920 --> 00:34:17,360
this person here has not received sleep, any sleep over 24 hours period of time or worse,

470
00:34:17,360 --> 00:34:19,320
48 hours or longer.

471
00:34:19,320 --> 00:34:25,560
So capturing those types of instances and relaying those up for informing safety related

472
00:34:25,560 --> 00:34:27,080
decisions.

473
00:34:27,080 --> 00:34:32,400
Risk decisions is what we're trying to look at really closely with the Navy.

474
00:34:32,400 --> 00:34:39,040
Also using these devices to be able to help shape, again, going back to the patterns over

475
00:34:39,040 --> 00:34:45,120
time and being able to kind of put how a health related decision might have an impact on your

476
00:34:45,120 --> 00:34:46,120
sleep.

477
00:34:46,120 --> 00:34:49,520
We're trying to work with individuals, like the individual sailor marine level to help

478
00:34:49,520 --> 00:34:52,360
them understand how they can utilize data, right?

479
00:34:52,360 --> 00:34:55,520
Like if you have too much alcohol before you go to sleep, guess what?

480
00:34:55,520 --> 00:34:59,560
You're going to see it in your heart rate, like your resting heart rate that night.

481
00:34:59,560 --> 00:35:00,560
It's going to go up.

482
00:35:00,560 --> 00:35:03,480
In your HRV, your heart rate variability is going to go down.

483
00:35:03,480 --> 00:35:08,000
So helping people put these things together so they can kind of get a sense of, hey, these

484
00:35:08,000 --> 00:35:11,860
are having a positive, these behaviors are having a positive impact on my sleep.

485
00:35:11,860 --> 00:35:14,520
These are having a negative impact on my sleep.

486
00:35:14,520 --> 00:35:19,600
And I often, when I'm talking to firefighters, I put it like that.

487
00:35:19,600 --> 00:35:22,600
They're a tool for insights, right?

488
00:35:22,600 --> 00:35:27,960
Not for basing night to night decision on how well or how poor you slept, but it's a

489
00:35:27,960 --> 00:35:33,360
tool that can help you collect insights over time so that you can best prioritize your

490
00:35:33,360 --> 00:35:35,240
sleep when you can.

491
00:35:35,240 --> 00:35:38,120
So that's really the two things we're doing with wearables.

492
00:35:38,120 --> 00:35:46,080
And the one thing that I'll let Allison talk is really trying to impress upon people when

493
00:35:46,080 --> 00:35:50,620
we're coming out there with these wearable devices that there are metrics that they're

494
00:35:50,620 --> 00:35:55,920
putting forward that are not validated in any way, shape, or form, like Garmin has a

495
00:35:55,920 --> 00:36:01,680
body battery metric or has a readiness algorithms or outputs.

496
00:36:01,680 --> 00:36:09,080
And we don't really see that these sort of readiness scores or body battery metrics correlate

497
00:36:09,080 --> 00:36:11,860
with anything meaningful.

498
00:36:11,860 --> 00:36:16,560
So to date, we haven't been able to find really a signal in there.

499
00:36:16,560 --> 00:36:24,000
So that's the thing that we want to caution folks on is putting a ton of stock in those

500
00:36:24,000 --> 00:36:27,680
sort of higher level metrics that these devices provide.

501
00:36:27,680 --> 00:36:30,200
Allison, anything to add?

502
00:36:30,200 --> 00:36:31,200
Yeah.

503
00:36:31,200 --> 00:36:35,240
I mean, to Rachel's point, this is sort of what we're doing with wearables too.

504
00:36:35,240 --> 00:36:37,440
Completely agree with everything she said.

505
00:36:37,440 --> 00:36:46,000
I mean, even before the user friendly wearables came on the market, like the Auras, the whoops,

506
00:36:46,000 --> 00:36:52,440
the Fitbits, the Garmin's, even the ActiWatch, which was the gold standard for 20 some years

507
00:36:52,440 --> 00:37:02,280
and still has the best reliability next to the gold standard of an actual sleep study.

508
00:37:02,280 --> 00:37:11,880
We had to create a completely separate list of criteria for how to sleep stage data collected

509
00:37:11,880 --> 00:37:15,040
on an ActiWatch, which was just a motion logger at the time.

510
00:37:15,040 --> 00:37:21,560
There weren't any really fancy algorithms because of these irregular schedules.

511
00:37:21,560 --> 00:37:29,520
But since then, I mean, when we are looking at sleep now and the populations I work with,

512
00:37:29,520 --> 00:37:31,360
there's huge emphasis on self-awareness.

513
00:37:31,360 --> 00:37:40,600
So we give out wearables, not so much to get them to track their daily sleep for the purpose

514
00:37:40,600 --> 00:37:44,020
of seeing if they're at risk for a sleep disorder.

515
00:37:44,020 --> 00:37:49,640
We give them wearables so that they can make active positive changes in their lifestyle.

516
00:37:49,640 --> 00:37:51,640
Alcohol is a big one.

517
00:37:51,640 --> 00:37:57,880
Ever since we started giving the population I work with wearables, we found that 70% of

518
00:37:57,880 --> 00:38:03,280
them drink less at night because they see what alcohol does to their sleep.

519
00:38:03,280 --> 00:38:06,880
They're better able to regulate their heart rate during workouts.

520
00:38:06,880 --> 00:38:12,080
They're able to realize that if they eat too close to bedtime, they don't sleep as well.

521
00:38:12,080 --> 00:38:16,400
And if they eat fast food instead of nutritional high-dense quality food, they don't sleep

522
00:38:16,400 --> 00:38:17,400
as well.

523
00:38:17,400 --> 00:38:22,480
So I think the self-awareness piece is the biggest thing to take away outside of trying

524
00:38:22,480 --> 00:38:27,840
to clinicize the data collected from wearables because you'll never get there.

525
00:38:27,840 --> 00:38:28,840
Yeah, absolutely.

526
00:38:28,840 --> 00:38:33,720
Yeah, I think one of the things that Russell said to me that I didn't realize, I think

527
00:38:33,720 --> 00:38:36,760
it was the EEG that monitors all around the head.

528
00:38:36,760 --> 00:38:40,320
He said even that was like a kind of white belt level science.

529
00:38:40,320 --> 00:38:44,160
And all of us think that this is gold standard and you can see inside the brain and all that

530
00:38:44,160 --> 00:38:45,160
stuff.

531
00:38:45,160 --> 00:38:49,760
So to then think a wristwatch or a ring is going to be able to have that level of analysis,

532
00:38:49,760 --> 00:38:53,000
obviously, when you understand it, you're like, oh, okay.

533
00:38:53,000 --> 00:38:55,840
So I think the HRV especially for us is a good one.

534
00:38:55,840 --> 00:39:00,720
Is this the day to do Murph or is this the day to just go for a walk with the dog?

535
00:39:00,720 --> 00:39:01,720
Yeah.

536
00:39:01,720 --> 00:39:02,720
Yeah.

537
00:39:02,720 --> 00:39:04,720
Well, I don't know.

538
00:39:04,720 --> 00:39:11,400
Even that too, I am also a believer in allostasis as well.

539
00:39:11,400 --> 00:39:18,720
So this idea that sometimes it's good to challenge your physiological state when you're already

540
00:39:18,720 --> 00:39:19,720
in a state of decline.

541
00:39:19,720 --> 00:39:22,680
I mean, that's what professional sports teams do, right?

542
00:39:22,680 --> 00:39:28,600
Is they break apart athletes and then they build them back up.

543
00:39:28,600 --> 00:39:31,800
So I don't know.

544
00:39:31,800 --> 00:39:38,320
I still have issues with using wearable data or recovery data collected from wearables

545
00:39:38,320 --> 00:39:41,520
to determine if you're going to do this workout or not.

546
00:39:41,520 --> 00:39:46,880
I think you should go ahead and do the workout, but just keep the intensity at a, you know,

547
00:39:46,880 --> 00:39:48,640
manage the intensity instead.

548
00:39:48,640 --> 00:39:52,360
Yeah, I couldn't agree more, Alison.

549
00:39:52,360 --> 00:39:54,440
I couldn't agree more.

550
00:39:54,440 --> 00:39:59,040
Well, I think where I've seen it in myself is if I've come off a 24 hour shift with no

551
00:39:59,040 --> 00:40:04,360
sleep and Murph is the workout, you know, or they say, I mean, I literally posted a

552
00:40:04,360 --> 00:40:06,920
video the other day on this, funny enough.

553
00:40:06,920 --> 00:40:11,360
I'd had a really, really horrendous couple of days and it was a family issue and there

554
00:40:11,360 --> 00:40:18,720
were snatches on the workout and the complexity of that movement made me so angry that I ended

555
00:40:18,720 --> 00:40:23,000
up just leaving the gym and going for a run instead because it was adding stress to stress

556
00:40:23,000 --> 00:40:24,080
by that point.

557
00:40:24,080 --> 00:40:26,120
So I think I don't wear wearables myself.

558
00:40:26,120 --> 00:40:31,120
I'd like to try and use the intuition, but there are absolutely days where, you know,

559
00:40:31,120 --> 00:40:32,760
we haven't slept for 24 hours.

560
00:40:32,760 --> 00:40:36,240
That's not the time to do a red line workout, you know, whether you're wearing a watch or

561
00:40:36,240 --> 00:40:37,240
not.

562
00:40:37,240 --> 00:40:40,240
Yeah, that is right.

563
00:40:40,240 --> 00:40:43,440
Snatches I can agree with, you know.

564
00:40:43,440 --> 00:40:45,440
Yeah, absolutely.

565
00:40:45,440 --> 00:40:46,440
All right.

566
00:40:46,440 --> 00:40:48,720
Well then, so that's kind of the ownership of the individual still.

567
00:40:48,720 --> 00:40:52,440
And this is the problem I see with the sleep conversation is every time it's mentioned

568
00:40:52,440 --> 00:40:56,040
in the fire service, like, oh, well, they just need to sleep more when they go home,

569
00:40:56,040 --> 00:40:57,040
go to bed early.

570
00:40:57,040 --> 00:41:00,240
There's never a looking in the mirror and go, well, why are we working these men and

571
00:41:00,240 --> 00:41:01,840
women so much?

572
00:41:01,840 --> 00:41:02,840
Why is this?

573
00:41:02,840 --> 00:41:06,360
I point out all the time that the person bagging your groceries or the barista in your coffee

574
00:41:06,360 --> 00:41:11,440
shop working 40 hours, but the person who's going to go from a fire station, from a pseudo

575
00:41:11,440 --> 00:41:15,760
sleep to, you know, driving through traffic and then entering a burning building, you're

576
00:41:15,760 --> 00:41:17,980
okay with them working 56.

577
00:41:17,980 --> 00:41:19,720
So I think that's pure insanity.

578
00:41:19,720 --> 00:41:25,120
And this this paradigm shift that's happening with this 24 72, I think is what we need to

579
00:41:25,120 --> 00:41:26,680
have as an industry standard.

580
00:41:26,680 --> 00:41:32,760
So when you can when we first talk, for example, when you first were exposed to the firefighter

581
00:41:32,760 --> 00:41:35,960
schedule, what was your impression?

582
00:41:35,960 --> 00:41:41,080
And then talk to me about the impact it would have if we put an extra 24 hours between these

583
00:41:41,080 --> 00:41:43,520
shifts in my in my profession specifically.

584
00:41:43,520 --> 00:41:46,880
Start with you, Rachel.

585
00:41:46,880 --> 00:41:55,560
Well, my initial reaction was, I think, one of.

586
00:41:55,560 --> 00:41:56,560
Dare I say, like horror.

587
00:41:56,560 --> 00:42:02,000
I mean, having a second night in that, you know, 48 scenario where they're on, they're

588
00:42:02,000 --> 00:42:09,320
there for 48 hours like that second night immediately was a concern to me because the

589
00:42:09,320 --> 00:42:13,360
assumption that they're not going to get a lot of, you know, potentially the necessary

590
00:42:13,360 --> 00:42:15,560
sleep they need on night one.

591
00:42:15,560 --> 00:42:19,160
So now they're going into a second night compromise.

592
00:42:19,160 --> 00:42:25,440
I do think it's the people, you know, the folks that are doing really critical service

593
00:42:25,440 --> 00:42:32,080
related jobs, critical functions of our society to have those folks be the most fatigued,

594
00:42:32,080 --> 00:42:33,320
like doesn't make any sense.

595
00:42:33,320 --> 00:42:38,080
I I hear what you're saying, James.

596
00:42:38,080 --> 00:42:41,320
Why are we anyway?

597
00:42:41,320 --> 00:42:48,920
But so how much so an additional 24 hours of rest?

598
00:42:48,920 --> 00:42:50,720
Yes, of rest.

599
00:42:50,720 --> 00:42:54,840
So we're talking now a potential three days in between.

600
00:42:54,840 --> 00:42:59,360
Well, it's funny because we use we as the fire service have used the days that we say

601
00:42:59,360 --> 00:43:00,940
one day on two days off.

602
00:43:00,940 --> 00:43:05,440
But actually, 24 hours is three eight hour days crammed together.

603
00:43:05,440 --> 00:43:09,800
And that second day is not a day off because they work from midnight to eight.

604
00:43:09,800 --> 00:43:13,800
So really, instead of one day off, you'd be giving them two days off.

605
00:43:13,800 --> 00:43:14,800
That's all it is.

606
00:43:14,800 --> 00:43:16,880
It sounds amazing when we say it the wrong way.

607
00:43:16,880 --> 00:43:20,600
But when you actually lay out properly, it's really not that impressive at all.

608
00:43:20,600 --> 00:43:21,960
It's a 42 hour workweek.

609
00:43:21,960 --> 00:43:24,160
So you're still working more than the barista.

610
00:43:24,160 --> 00:43:25,160
Yeah.

611
00:43:25,160 --> 00:43:26,160
Yeah.

612
00:43:26,160 --> 00:43:31,240
And well, I think there's a number of laboratory studies that are published and well cited

613
00:43:31,240 --> 00:43:36,400
that indicate that you don't, you know, from a cognitive perspective, depending on what

614
00:43:36,400 --> 00:43:41,360
sort of cognitive task area we're measuring, you're not going to be restored to baseline

615
00:43:41,360 --> 00:43:43,320
from a single night.

616
00:43:43,320 --> 00:43:45,320
You do need additional nights.

617
00:43:45,320 --> 00:43:46,400
Right.

618
00:43:46,400 --> 00:43:52,280
And so having an additional period of time to help recover is going to be helpful.

619
00:43:52,280 --> 00:43:53,280
To what extent?

620
00:43:53,280 --> 00:43:59,000
And I don't know, because, again, lack of data, of course, is a problem.

621
00:43:59,000 --> 00:44:01,360
But yes, absolutely.

622
00:44:01,360 --> 00:44:06,320
The more and I have the same kind of conversation when I'm talking with Navy folks and hey,

623
00:44:06,320 --> 00:44:13,680
what can we do to maximize recovery, you know, during a deployment, for instance, and it's

624
00:44:13,680 --> 00:44:17,760
like, well, one night's probably it's going to get you closer, but it's not going to get

625
00:44:17,760 --> 00:44:19,760
you all the way.

626
00:44:19,760 --> 00:44:21,600
Right.

627
00:44:21,600 --> 00:44:25,680
So I don't think it's going to be hurtful to have an extra day.

628
00:44:25,680 --> 00:44:27,920
I think it's only going to have positive benefits.

629
00:44:27,920 --> 00:44:31,720
Now they need to prioritize that time and sleep.

630
00:44:31,720 --> 00:44:32,720
Right.

631
00:44:32,720 --> 00:44:35,440
And get that opportunity to sleep during that period.

632
00:44:35,440 --> 00:44:37,520
But, yeah, also.

633
00:44:37,520 --> 00:44:45,840
Yeah, I mean, initially, it's when I first got introduced to the fire service, you know,

634
00:44:45,840 --> 00:44:52,240
I used to complain about when, like the few times I've stayed awake for longer than 24

635
00:44:52,240 --> 00:44:55,320
hours while deployed, like how awful it was.

636
00:44:55,320 --> 00:45:00,440
And then realizing that there's a sector of our society who does this every day, every

637
00:45:00,440 --> 00:45:04,520
week, every month for years on end.

638
00:45:04,520 --> 00:45:07,520
It's just it's baffling to me.

639
00:45:07,520 --> 00:45:17,840
But I think the thing I'll add is there needs to just be this commitment or sort of cultural

640
00:45:17,840 --> 00:45:24,080
incentive to encourage people for their rest days to really use it as recovery and not

641
00:45:24,080 --> 00:45:30,920
for a second job, because that's, you know, that's the popular anecdotal evidence we see

642
00:45:30,920 --> 00:45:35,800
time and time again working with these different fire departments is the more hours in the

643
00:45:35,800 --> 00:45:42,080
shift you add, which hypothetically gives them more time to nap or take little breaks

644
00:45:42,080 --> 00:45:46,480
here and there, the more time off they get.

645
00:45:46,480 --> 00:45:51,560
But they fill that time off with second jobs instead of using it to rest.

646
00:45:51,560 --> 00:45:56,600
So you know, I don't think we'll ever have a right answer.

647
00:45:56,600 --> 00:46:02,040
I think we'll have that we can work towards an optimal answer.

648
00:46:02,040 --> 00:46:05,840
But there needs to be a commitment that comes with that, whether it's, you know, having

649
00:46:05,840 --> 00:46:10,240
people sign sort of like, you know, us as government employees, we're not allowed to

650
00:46:10,240 --> 00:46:12,420
work for companies, right?

651
00:46:12,420 --> 00:46:13,640
We work for the government.

652
00:46:13,640 --> 00:46:20,220
So like having them sign a disclosure agreement that they can't have a second job.

653
00:46:20,220 --> 00:46:27,000
But you know, it's it certainly is a contentious and tricky situation.

654
00:46:27,000 --> 00:46:33,880
So where I think it's become contentious and tricky is it the extra work is usually more

655
00:46:33,880 --> 00:46:36,160
shifts at the fire station.

656
00:46:36,160 --> 00:46:39,040
And so I've had this I've had chiefs say, well, if we give them more time off, they're

657
00:46:39,040 --> 00:46:40,660
just going to work more.

658
00:46:40,660 --> 00:46:45,320
I would argue that if you, you know, on your second, you know, your days off, you were

659
00:46:45,320 --> 00:46:51,480
personal training during nine to five hours, or painting houses or landscaping or, you

660
00:46:51,480 --> 00:46:55,840
know, carpentry or whatever it was, I wouldn't think that was detrimental.

661
00:46:55,840 --> 00:46:59,520
But if you're taking another shift at a fire department or working overnight in the ER

662
00:46:59,520 --> 00:47:03,440
or an ambulance, and absolutely as a whole different conversation.

663
00:47:03,440 --> 00:47:07,640
But if you are going to have a second career that ultimately you can transition into once

664
00:47:07,640 --> 00:47:10,200
you leave the fire department, you get hurt.

665
00:47:10,200 --> 00:47:12,400
I think that's actually a very valuable tool.

666
00:47:12,400 --> 00:47:15,640
So I think that those two have kind of got mushed together.

667
00:47:15,640 --> 00:47:18,520
Because I think the contention is just are they sleeping at night?

668
00:47:18,520 --> 00:47:22,920
Well, if you hand drywall for eight hours, making extra money because a lot of fire departments

669
00:47:22,920 --> 00:47:26,600
don't pay very well, then you're still going to go and have dinner with your family is

670
00:47:26,600 --> 00:47:29,880
still going to unwind that evening, you're still going to get a solid night's sleep.

671
00:47:29,880 --> 00:47:33,280
Yeah, that is true.

672
00:47:33,280 --> 00:47:34,280
That's a good point.

673
00:47:34,280 --> 00:47:36,520
Yeah, I mean, the work matters.

674
00:47:36,520 --> 00:47:37,520
Absolutely.

675
00:47:37,520 --> 00:47:42,960
But that's key is to not be extending yourself into the nighttime hours for work and whatever

676
00:47:42,960 --> 00:47:46,440
it is, instead of using that time to recover.

677
00:47:46,440 --> 00:47:47,440
That's right.

678
00:47:47,440 --> 00:47:50,880
Yeah, I think that's where the education comes in.

679
00:47:50,880 --> 00:47:55,120
Yeah, that the education piece is huge.

680
00:47:55,120 --> 00:47:56,120
Yeah.

681
00:47:56,120 --> 00:48:02,720
All right, well, then kind of shifting from them, Allison, please jump in at performance

682
00:48:02,720 --> 00:48:06,960
and what these men and women are expected to do at the drop of a hat.

683
00:48:06,960 --> 00:48:08,760
You know, it's a no brainer there.

684
00:48:08,760 --> 00:48:14,400
Let's talk about the kind of chronic impact, which I know is less prominent in the military

685
00:48:14,400 --> 00:48:20,660
because a lot of your men and women in uniform aren't serving for 20, 30 years at a time.

686
00:48:20,660 --> 00:48:25,480
With mental health specifically, what have you seen as far as the connection between

687
00:48:25,480 --> 00:48:32,560
disrupted or sleep deprivation and a downward spiral when it comes to mental health?

688
00:48:32,560 --> 00:48:38,080
Yeah, I can I can I can start.

689
00:48:38,080 --> 00:48:41,760
I mean, we do have folks that serve for decades.

690
00:48:41,760 --> 00:48:42,760
Right.

691
00:48:42,760 --> 00:48:49,720
And they are subjected to chronic sleep deficiency, I would call it.

692
00:48:49,720 --> 00:48:57,280
I think that the concerns are obviously what that translates to in terms of their mental

693
00:48:57,280 --> 00:49:03,160
and physical health outcomes at the time, but then later.

694
00:49:03,160 --> 00:49:10,520
What are you stepping into as you retire in terms of your own physical and mental health?

695
00:49:10,520 --> 00:49:16,560
When we go out in in SS sleep with the active duty military that we're working with, we

696
00:49:16,560 --> 00:49:21,880
always almost always ask questions related to their mental health, their emotional health

697
00:49:21,880 --> 00:49:23,600
and their physical health.

698
00:49:23,600 --> 00:49:29,200
Now we aren't doing deep dives, at least within my my team.

699
00:49:29,200 --> 00:49:38,000
But some are using sort of more valid validated clinically validated surveys and tools.

700
00:49:38,000 --> 00:49:44,240
But we always get a sense from them as to what their status of their mental health is.

701
00:49:44,240 --> 00:49:50,440
And I don't think there's a single data collection that hasn't shown an association between the

702
00:49:50,440 --> 00:49:54,280
amount of sleep that they're getting and the quality of sleep that they're getting and

703
00:49:54,280 --> 00:49:56,720
their mental health.

704
00:49:56,720 --> 00:50:00,840
Now we don't always see on the physical health side, at least from their perception, again,

705
00:50:00,840 --> 00:50:06,640
this is self-report, but from the mental health standpoint, we almost always see and sometimes

706
00:50:06,640 --> 00:50:10,040
emotional health as well.

707
00:50:10,040 --> 00:50:14,740
We Navy, you know, and this isn't just Navy, but all the services care a heck of a lot

708
00:50:14,740 --> 00:50:16,240
about suicide.

709
00:50:16,240 --> 00:50:17,240
Right.

710
00:50:17,240 --> 00:50:23,560
And as sleep scientists, we know that there are these strong associations between the

711
00:50:23,560 --> 00:50:31,640
likelihood of getting depression and, you know, having not slept enough or well enough.

712
00:50:31,640 --> 00:50:39,160
And then that potentially translating down to suicidal ideation and suicide.

713
00:50:39,160 --> 00:50:46,920
But so, yeah, I would say there's generally an awareness of this, the data support, those

714
00:50:46,920 --> 00:50:51,600
associations and we're seeing in operational research.

715
00:50:51,600 --> 00:50:53,880
But yeah, that's where it is.

716
00:50:53,880 --> 00:50:56,880
That's where we stand.

717
00:50:56,880 --> 00:50:57,880
Alison.

718
00:50:57,880 --> 00:50:58,880
Yeah.

719
00:50:58,880 --> 00:51:04,040
You know, to Rachel's point, empirically, through the data we've collected as part of

720
00:51:04,040 --> 00:51:09,880
some of the army, we've done these mental health advisory teams during the global war

721
00:51:09,880 --> 00:51:17,120
on terrorism where we embedded ourselves in different units and captured the current state

722
00:51:17,120 --> 00:51:18,920
of sleep and mental health.

723
00:51:18,920 --> 00:51:25,240
We always see an association between levels and severity of chronic sleep loss and impact

724
00:51:25,240 --> 00:51:28,080
on mental health.

725
00:51:28,080 --> 00:51:32,680
So that's, you know, in our data to showing similar trends.

726
00:51:32,680 --> 00:51:40,800
And anecdotally now, like, you know, I serve with a generation of leaders who just came

727
00:51:40,800 --> 00:51:46,120
back from war after 17, 18 years getting ready to retire have spent pretty much their entire

728
00:51:46,120 --> 00:51:50,760
career since 9 11, just outside the wire.

729
00:51:50,760 --> 00:51:56,160
And the significant toll it's taken on their mental health long term.

730
00:51:56,160 --> 00:52:01,840
You know, and they're all many of them are enrolled in programs now to help cope, deal

731
00:52:01,840 --> 00:52:11,720
with trauma, but not just trauma, just learned how to, you know, work on themselves and to

732
00:52:11,720 --> 00:52:14,560
better their mental health.

733
00:52:14,560 --> 00:52:25,760
So it's it there definitely is an extremely strong and intimate link that I think is even

734
00:52:25,760 --> 00:52:35,560
even with some of the research is not as not as salient as what, you know, Rachel and I

735
00:52:35,560 --> 00:52:42,400
see in daily life talking with different soldiers and sailors we work with.

736
00:52:42,400 --> 00:52:44,040
What about recruitment?

737
00:52:44,040 --> 00:52:48,560
What's interesting and this has been from a military guest and first responders, you

738
00:52:48,560 --> 00:52:53,680
know, 20 years ago when I first went in, even though I didn't come from a firefighter family,

739
00:52:53,680 --> 00:52:57,700
there were so many people in my academy, so many people I got hired with that were sons

740
00:52:57,700 --> 00:53:01,000
and daughters of firefighters or police officers.

741
00:53:01,000 --> 00:53:05,520
And you had people in uniform, a lot of them saying, yeah, this is a great career and telling

742
00:53:05,520 --> 00:53:11,120
the kids that they coached in t ball or whatever it was now fast forward 20 years rather than

743
00:53:11,120 --> 00:53:14,920
testing against thousands of people that I had to do.

744
00:53:14,920 --> 00:53:17,300
Departments are having to choose almost everyone from a list.

745
00:53:17,300 --> 00:53:19,560
Anyone that shows up, they pretty much get a job.

746
00:53:19,560 --> 00:53:24,960
And I'm hearing, you know, soldiers, firefighters, police officers saying, I do not want my kid

747
00:53:24,960 --> 00:53:26,480
to do this anymore.

748
00:53:26,480 --> 00:53:28,560
And it's not because of the job itself.

749
00:53:28,560 --> 00:53:29,920
It's the working conditions.

750
00:53:29,920 --> 00:53:33,860
It's the lack of support with, you know, if you're in law enforcement, what are you seeing

751
00:53:33,860 --> 00:53:34,880
as far as that?

752
00:53:34,880 --> 00:53:38,860
Because obviously, as you mentioned, you got a lot of people that serve for a long time.

753
00:53:38,860 --> 00:53:42,720
Some may feel a certain way as to whether they should have been in Iraq or the way that

754
00:53:42,720 --> 00:53:45,040
we drew from Afghanistan.

755
00:53:45,040 --> 00:53:48,320
Are you seeing that kind of multi-generational element?

756
00:53:48,320 --> 00:53:53,240
Are you seeing soldiers excited for the next generation of soldiers?

757
00:53:53,240 --> 00:53:58,240
Or are we kind of paying the price now from some of the poor leadership in the past?

758
00:53:58,240 --> 00:54:05,480
Well, it's just so fitting that I've been traveling around the country for the last

759
00:54:05,480 --> 00:54:12,840
few months, trying to develop good, healthy sleep habits, despite being in different time

760
00:54:12,840 --> 00:54:18,040
zones working on this recruiting problem.

761
00:54:18,040 --> 00:54:31,960
I think there is a generational gap, but I think it's less about hearing about the negative

762
00:54:31,960 --> 00:54:41,560
aspects of military, or I should say the negative consequences of war fighting.

763
00:54:41,560 --> 00:54:48,040
So sleep deprivation, combat-related trauma impacts on mental health.

764
00:54:48,040 --> 00:54:58,760
I think it's more of a generation that wants a nine-to-five job and to make significant

765
00:54:58,760 --> 00:55:06,820
is more interested in life and quality of life around financial capital and financial

766
00:55:06,820 --> 00:55:10,440
security than selfless service.

767
00:55:10,440 --> 00:55:17,120
So that's just, I wouldn't say a personal opinion, but it's something that we've more

768
00:55:17,120 --> 00:55:21,080
or less noticed about this generation in terms of the recruitment problem.

769
00:55:21,080 --> 00:55:25,600
Rachel, I'll let you jump in before I kind of give my two cents.

770
00:55:25,600 --> 00:55:31,480
Yeah, well, I was just going to say, we're not in our efforts, we're not necessarily

771
00:55:31,480 --> 00:55:33,840
directly asking folks that question.

772
00:55:33,840 --> 00:55:38,360
The question of how willing are you to sign another contract?

773
00:55:38,360 --> 00:55:46,120
Or how willing are you to endorse naval service to someone else?

774
00:55:46,120 --> 00:55:52,920
So I don't feel like I can give you like an evidence-based answer here.

775
00:55:52,920 --> 00:55:58,120
There's just a lot of assumptions in sort of connecting of dots.

776
00:55:58,120 --> 00:56:03,880
And I think you have high stress environments and root causes.

777
00:56:03,880 --> 00:56:10,680
So you have root causes that contribute to these stressors, some of which are necessary,

778
00:56:10,680 --> 00:56:11,680
some of which aren't going away.

779
00:56:11,680 --> 00:56:14,360
I mean, that's part of service.

780
00:56:14,360 --> 00:56:21,960
Others are as a result of potentially not having enough folks available to put in and

781
00:56:21,960 --> 00:56:24,840
workload, overall workload and things like that.

782
00:56:24,840 --> 00:56:35,880
But it's high stress carried out over time, potentially you're not letting folks recover

783
00:56:35,880 --> 00:56:38,760
in the way that they need to and they may not want to stay in.

784
00:56:38,760 --> 00:56:41,040
But that's just making some leaps.

785
00:56:41,040 --> 00:56:45,800
I don't necessarily feel like I can comment on more from the Navy perspective since I

786
00:56:45,800 --> 00:56:48,600
don't have that data.

787
00:56:48,600 --> 00:56:52,900
But certainly there's a good rationale there.

788
00:56:52,900 --> 00:56:57,800
From the first responder profession, and I'm hearing this a lot from these firefighters

789
00:56:57,800 --> 00:57:03,720
and police officers and EMTs and paramedics and corrections officers, it's not the job

790
00:57:03,720 --> 00:57:04,720
itself.

791
00:57:04,720 --> 00:57:05,720
And I'll give you a perfect example.

792
00:57:05,720 --> 00:57:10,740
I had a firefighter wife on the show and they have a son who, when he was younger, was always

793
00:57:10,740 --> 00:57:14,240
wearing the firefighter gear and would be out in the garden with the hose and all that

794
00:57:14,240 --> 00:57:15,240
stuff.

795
00:57:15,240 --> 00:57:20,000
And then he turned into a teenager and they asked him one day, do you still want to be

796
00:57:20,000 --> 00:57:21,000
a firefighter?

797
00:57:21,000 --> 00:57:22,720
And he said, no.

798
00:57:22,720 --> 00:57:23,720
And they said, well, why not?

799
00:57:23,720 --> 00:57:26,560
And he said, because daddy's never home.

800
00:57:26,560 --> 00:57:28,240
It wasn't, I don't want to go into fires.

801
00:57:28,240 --> 00:57:30,480
It wasn't, I don't want to see bad stuff.

802
00:57:30,480 --> 00:57:34,240
It was the fact that, and this was again, mandatory overtime, all that stuff, that the

803
00:57:34,240 --> 00:57:36,040
parent was never home.

804
00:57:36,040 --> 00:57:41,360
So you couple that with a generation that do value their mental health, their emotional

805
00:57:41,360 --> 00:57:43,280
health, their relationships.

806
00:57:43,280 --> 00:57:44,840
I believe there's a happy medium.

807
00:57:44,840 --> 00:57:47,840
Yes, you're going to have to be selfless and serve and you're going to have to be gone

808
00:57:47,840 --> 00:57:49,600
for 24 hours.

809
00:57:49,600 --> 00:57:53,880
But if the environment is so bad, like it is in the fire service at the moment, I believe

810
00:57:53,880 --> 00:57:59,080
these young people are looking on paper because you can now in 2024 and see all the cool stuff,

811
00:57:59,080 --> 00:58:01,240
the mustaches and the cats and trees.

812
00:58:01,240 --> 00:58:06,120
But you see also the sleep deprivation and divorces, the cancers, the destroyed testosterone,

813
00:58:06,120 --> 00:58:07,420
all the things.

814
00:58:07,420 --> 00:58:08,420
And they're going, you know what?

815
00:58:08,420 --> 00:58:09,420
It doesn't sound very good.

816
00:58:09,420 --> 00:58:10,500
UPS is hiring.

817
00:58:10,500 --> 00:58:13,380
I won't get to serve, but at least I'll be home every day.

818
00:58:13,380 --> 00:58:17,520
So I think that there's a conversation to bring it into the middle.

819
00:58:17,520 --> 00:58:21,560
Yes, you still need that selfless servant type of person.

820
00:58:21,560 --> 00:58:26,720
But if we're not creating an environment that attracts people and says we value as a firefighter,

821
00:58:26,720 --> 00:58:28,000
we will take care of your health.

822
00:58:28,000 --> 00:58:32,280
If you're willing to sacrifice your time and come and do this, if we're not fixing that

823
00:58:32,280 --> 00:58:36,760
part, we're not going to have a fire service anymore because they're scratching at crumbs

824
00:58:36,760 --> 00:58:37,760
now.

825
00:58:37,760 --> 00:58:41,720
Yeah, no, I can agree with that too.

826
00:58:41,720 --> 00:58:48,000
You know, those are other issues that we've heard about recruitment as well.

827
00:58:48,000 --> 00:58:55,760
At least in people who have generational service in the military.

828
00:58:55,760 --> 00:59:00,160
Well, I want to hit another topic because I just stumbled across it when I was monologuing

829
00:59:00,160 --> 00:59:01,160
then.

830
00:59:01,160 --> 00:59:06,880
Talk to me about the impact of sleep deprivation and hormone levels, especially testosterone.

831
00:59:06,880 --> 00:59:11,220
Because when I look, you know, this is again observational, but it's everywhere.

832
00:59:11,220 --> 00:59:16,560
If I ask a 30 year old firefighter, if I randomly select one that works anywhere where they

833
00:59:16,560 --> 00:59:22,400
run any amount of calls, I guarantee you that they'll either be on TRT or that they'll say

834
00:59:22,400 --> 00:59:24,920
their number is like 300.

835
00:59:24,920 --> 00:59:29,280
And what I'm seeing at the moment is, you know, there's a predatory arm to these men's

836
00:59:29,280 --> 00:59:34,040
clinics that rather than having the conversation of let's get them more sleep, which is what

837
00:59:34,040 --> 00:59:39,520
I'm trying to do, and get them to exercise and eat well and do mindfulness and be outside,

838
00:59:39,520 --> 00:59:43,540
they're like, oh, no, you just need to take this injection and you'll be fine.

839
00:59:43,540 --> 00:59:46,680
And now you've got this person that have problems with their reproduction, they're losing their

840
00:59:46,680 --> 00:59:50,600
hair and they're on this stuff for the rest of their life.

841
00:59:50,600 --> 00:59:53,740
So that was kind of like I preloaded that question.

842
00:59:53,740 --> 00:59:58,560
But talk to me about the start with you, Rachel, the connection between sleep deprivation and

843
00:59:58,560 --> 01:00:00,000
our hormonal health.

844
01:00:00,000 --> 01:00:06,800
Yeah, I mean, I can only look to the laboratory studies, right, that have been published,

845
01:00:06,800 --> 01:00:13,720
where we understand that there is a role in sleep deprivation with testosterone levels.

846
01:00:13,720 --> 01:00:19,400
And we do see, you know, those folks who are sort of artificially constricted to, you know,

847
01:00:19,400 --> 01:00:23,600
five hours of sleep, for instance, for several days that you see like a 10 to 15 percent

848
01:00:23,600 --> 01:00:27,840
drop in testosterone levels, right?

849
01:00:27,840 --> 01:00:34,400
Now the prevalence of T8, like actually using testosterone replacement therapy is something

850
01:00:34,400 --> 01:00:39,920
that's I think completely unknown right now in what we release within the communities

851
01:00:39,920 --> 01:00:40,920
I'm working with.

852
01:00:40,920 --> 01:00:47,440
At least I'm unaware of any research that has looked at sort of the general purpose

853
01:00:47,440 --> 01:00:49,120
sort of Navy in this concept.

854
01:00:49,120 --> 01:00:55,600
Now, I know, and now you can probably comment a little bit more here, special operations,

855
01:00:55,600 --> 01:00:56,600
that might be different.

856
01:00:56,600 --> 01:01:01,040
I know there are folks who have looked at it there.

857
01:01:01,040 --> 01:01:05,680
But that's certainly not something that it's not a topic that we're really talking about

858
01:01:05,680 --> 01:01:09,360
when it comes to this sort of general purpose force.

859
01:01:09,360 --> 01:01:15,000
But I am well aware of this practice, especially having spoken with and worked with firefighters

860
01:01:15,000 --> 01:01:19,120
and other emergency responders for years.

861
01:01:19,120 --> 01:01:25,240
And if you ask Rachel's opinion on it, this is Rachel's opinion, I think there are clear

862
01:01:25,240 --> 01:01:33,000
cases where it is necessary, but I think there's probably a jump to that step without doing

863
01:01:33,000 --> 01:01:39,720
what you're doing, what you're promoting, James, which is let's address issues causing

864
01:01:39,720 --> 01:01:44,520
the lower testosterone levels to begin with and address them in a healthy way.

865
01:01:44,520 --> 01:01:50,400
So yeah, I think that could become more problematic.

866
01:01:50,400 --> 01:01:54,880
But to what extent that's happening right now and sort of the more general purpose force

867
01:01:54,880 --> 01:01:57,840
with Navy, just don't know.

868
01:01:57,840 --> 01:01:58,840
Allison?

869
01:01:58,840 --> 01:02:02,160
Yeah, so I could speak on it two levels.

870
01:02:02,160 --> 01:02:05,320
I mean, first, you're absolutely right.

871
01:02:05,320 --> 01:02:08,920
People just, it's just like everything else in society.

872
01:02:08,920 --> 01:02:15,560
We want a pill, we want a patch, we want something injected into us to solve the problem instead

873
01:02:15,560 --> 01:02:18,880
of doing the real hard work.

874
01:02:18,880 --> 01:02:25,000
Where I live, I live in a very unique community and we have functional medicine clinics all

875
01:02:25,000 --> 01:02:31,200
the time advertising for testosterone replacement therapy and all the above.

876
01:02:31,200 --> 01:02:39,040
We did do a field study that published data a few years ago with a unit transitioning

877
01:02:39,040 --> 01:02:46,160
from daytime to nighttime operations and we found a complete arrest of testosterone secretion

878
01:02:46,160 --> 01:02:47,320
during that time.

879
01:02:47,320 --> 01:02:52,680
Makes sense, they're awake during the night, so they weren't going to secrete testosterone.

880
01:02:52,680 --> 01:03:01,560
So when you looked at their testosterone the next day, it was very extremely low.

881
01:03:01,560 --> 01:03:10,600
But where I work, we do have programs where people can stabilize and optimize their hormonal

882
01:03:10,600 --> 01:03:14,680
profiles despite everything else.

883
01:03:14,680 --> 01:03:16,520
But it's never the first line of defense.

884
01:03:16,520 --> 01:03:18,480
It's the third line of defense.

885
01:03:18,480 --> 01:03:22,640
They work with the nutritionists, they work with the strength and conditioning coach,

886
01:03:22,640 --> 01:03:27,800
they work with the behavioral health or the mental performance staff first to stabilize

887
01:03:27,800 --> 01:03:34,560
everything else in their life before they begin some sort of optimization strategy.

888
01:03:34,560 --> 01:03:35,560
Yeah.

889
01:03:35,560 --> 01:03:43,040
Well, Alison, staying with you, you were a CrossFit athlete for the military themselves.

890
01:03:43,040 --> 01:03:47,040
When you meet all these young recruits, I think one of the things, I've heard a lot

891
01:03:47,040 --> 01:03:48,480
of good things about this generation.

892
01:03:48,480 --> 01:03:54,280
Of course, we have a nation that is 70% overweight and 40% obese.

893
01:03:54,280 --> 01:03:59,200
So clearly, the pool that we're getting to draw from is shrinking and that's heartbreaking.

894
01:03:59,200 --> 01:04:02,480
But what a lot of people are telling me is that the fit candidates that we're getting

895
01:04:02,480 --> 01:04:05,380
now are really fit, are in great shape.

896
01:04:05,380 --> 01:04:08,040
What are you seeing as far as the military side?

897
01:04:08,040 --> 01:04:13,240
Yeah, I mean, you really see the two extremes.

898
01:04:13,240 --> 01:04:22,480
I think, well, I mean, the populations we get, they're unique in that we, you know,

899
01:04:22,480 --> 01:04:28,000
very, more often than not, they come in extremely fit either off the streets or they already

900
01:04:28,000 --> 01:04:36,120
were in service and they come to us, you know, already having the top PT score in their unit

901
01:04:36,120 --> 01:04:39,560
and command.

902
01:04:39,560 --> 01:04:45,040
But yeah, it's a significant problem in the conventional army, I could say.

903
01:04:45,040 --> 01:04:51,720
You know, I have friends who are now battalion brigade commanders at basic training.

904
01:04:51,720 --> 01:04:56,200
I was in the recruiting command when I was on the CrossFit team and yeah, we see it too.

905
01:04:56,200 --> 01:05:03,220
It's, you know, I think in the current state, like physical fitness is an issue of national

906
01:05:03,220 --> 01:05:07,880
security and we have a huge national security concern.

907
01:05:07,880 --> 01:05:12,240
You know, if I was king for the day, I would bring, or queen for the day, I would bring

908
01:05:12,240 --> 01:05:14,960
back the presidential fitness test.

909
01:05:14,960 --> 01:05:20,120
I would bring back all those, you know, hard things we used to do in gym class, like rope

910
01:05:20,120 --> 01:05:24,840
climbs and the parachute and the scooter races, all those things that they don't do anymore.

911
01:05:24,840 --> 01:05:30,560
I can confidently say there's a lot of school systems out there who don't even have gym

912
01:05:30,560 --> 01:05:37,160
class because when we would go as the CrossFit team into these communities to promote and

913
01:05:37,160 --> 01:05:42,360
recruit by being the honorary gym teacher for the day, like we'd find out that they

914
01:05:42,360 --> 01:05:44,680
don't have gym anymore.

915
01:05:44,680 --> 01:05:47,880
So it is a problem, but it's a systemic problem, right?

916
01:05:47,880 --> 01:05:55,040
It's a society problem and, you know, it's not a service related problem.

917
01:05:55,040 --> 01:05:56,560
You mentioned queen or king for a day.

918
01:05:56,560 --> 01:05:58,400
I want to put this onto you for a moment.

919
01:05:58,400 --> 01:06:03,080
The problem with the fire service is all we've been talking about is how to try and quell

920
01:06:03,080 --> 01:06:05,380
the fact that we're killing them.

921
01:06:05,380 --> 01:06:09,040
The other side of the coin is actually forging human performance.

922
01:06:09,040 --> 01:06:13,320
And this is like almost non-existent in the fire service because how can you forge human

923
01:06:13,320 --> 01:06:17,320
performance when you're working 56, 80 hours a week and not sleeping every two or three

924
01:06:17,320 --> 01:06:19,320
days?

925
01:06:19,320 --> 01:06:20,760
So Rachel, I'll start with you.

926
01:06:20,760 --> 01:06:22,680
Queen for a day.

927
01:06:22,680 --> 01:06:28,020
If you could actually create an environment where the firefighters of the country have

928
01:06:28,020 --> 01:06:34,360
an environment where they can actually forge elite human performance as a tactical athlete,

929
01:06:34,360 --> 01:06:36,360
what would that look like?

930
01:06:36,360 --> 01:06:38,760
Well, this is fun.

931
01:06:38,760 --> 01:06:40,560
I like this exercise.

932
01:06:40,560 --> 01:06:41,960
All right.

933
01:06:41,960 --> 01:06:48,400
Well firstly, this is keeping sort of the knowns that we have, the constraints that

934
01:06:48,400 --> 01:06:49,400
are there that are known.

935
01:06:49,400 --> 01:06:54,000
They got to sleep at the firehouse, right?

936
01:06:54,000 --> 01:06:55,000
Stuff like that.

937
01:06:55,000 --> 01:07:01,240
But with the understanding that like the ideal would be that that only occurs over a 24 hour

938
01:07:01,240 --> 01:07:03,560
period of time in the 24 72 schedule, right?

939
01:07:03,560 --> 01:07:04,800
And then they can go home.

940
01:07:04,800 --> 01:07:11,200
So I'd look at it as like optimizing their health in two ways.

941
01:07:11,200 --> 01:07:16,680
So one would be what sleep they're able to get at the firehouse, right?

942
01:07:16,680 --> 01:07:21,800
And the other would be prioritizing sleep and all health related decisions and their

943
01:07:21,800 --> 01:07:23,600
home environment.

944
01:07:23,600 --> 01:07:31,880
So while at the firehouse, we know the basics like getting daily exercise, right?

945
01:07:31,880 --> 01:07:37,760
Getting sunlight exposure during the daytime and sort of minimizing as much as possible

946
01:07:37,760 --> 01:07:39,420
that at night.

947
01:07:39,420 --> 01:07:45,080
Those are having access to a gym would be great and not one that they'd have to presumably

948
01:07:45,080 --> 01:07:46,080
travel to.

949
01:07:46,080 --> 01:07:50,600
But it's right there for multiple reasons why that would be ideal.

950
01:07:50,600 --> 01:07:57,960
But in high quality equipment, as we see this often with with the Navy ships, you know,

951
01:07:57,960 --> 01:08:07,280
there's just equipment is can become beat up and maybe non-functional sometimes.

952
01:08:07,280 --> 01:08:11,520
And so having high quality equipment, I think, is really important in ways in which that

953
01:08:11,520 --> 01:08:14,480
they can while they're there in that environment.

954
01:08:14,480 --> 01:08:20,520
And it's also promoted the practice of being able to get a nap and sleep during the daytime.

955
01:08:20,520 --> 01:08:21,520
Right.

956
01:08:21,520 --> 01:08:22,520
When possible.

957
01:08:22,520 --> 01:08:24,200
And it's not frowned upon.

958
01:08:24,200 --> 01:08:25,200
It's encouraged.

959
01:08:25,200 --> 01:08:29,560
There's there's room and space to do that in a comfortable way.

960
01:08:29,560 --> 01:08:36,640
Now their sister, their nighttime sleep situation, that's a place we can optimize for sure, too.

961
01:08:36,640 --> 01:08:42,520
And we want to minimize obviously, like any any calls that aren't impacting that group

962
01:08:42,520 --> 01:08:45,520
in particular so they can sleep.

963
01:08:45,520 --> 01:08:49,260
That's like step one from more of an organizational standpoint.

964
01:08:49,260 --> 01:08:54,160
So I'd change I'd make sure that it's just affecting the people who needs to affect.

965
01:08:54,160 --> 01:08:56,680
And this is happening, I know, throughout.

966
01:08:56,680 --> 01:08:59,560
But that is so important.

967
01:08:59,560 --> 01:09:01,960
Next would be the actual sleep environment.

968
01:09:01,960 --> 01:09:07,680
And you know, obviously, the more we can, you know, how folks set up with their own

969
01:09:07,680 --> 01:09:13,080
room or just minimal share space with others is good, because, as we see with like Navy

970
01:09:13,080 --> 01:09:19,200
folks like you can have that snore, you know, that's and I've had some funny

971
01:09:19,200 --> 01:09:24,280
conversations with firefighters over the years about, you know, joking about how they'll

972
01:09:24,280 --> 01:09:30,280
give a certain position or certain bed location to a certain firefighter who tends to be that

973
01:09:30,280 --> 01:09:33,280
person in the gym.

974
01:09:33,280 --> 01:09:34,280
Yeah.

975
01:09:34,280 --> 01:09:35,280
Yeah.

976
01:09:35,280 --> 01:09:39,840
And but yeah, like being able to minimize the noise in that environment and a comfortable

977
01:09:39,840 --> 01:09:41,960
space to sleep.

978
01:09:41,960 --> 01:09:46,080
So that includes like that the actual mattress and consideration.

979
01:09:46,080 --> 01:09:52,440
I had a recent conversation with chief, our chief, where we discussed their mattresses

980
01:09:52,440 --> 01:09:57,320
that have, you know, more of a firm side and also more of a soft side because people have

981
01:09:57,320 --> 01:09:59,760
their individual differences here.

982
01:09:59,760 --> 01:10:02,280
We're actually doing a lot of mattress research for the Navy right now.

983
01:10:02,280 --> 01:10:04,280
So really cute into this.

984
01:10:04,280 --> 01:10:07,840
So giving people the option to just flip a mattress over, get a better night's sleep.

985
01:10:07,840 --> 01:10:09,560
Yeah, that would be amazing.

986
01:10:09,560 --> 01:10:10,560
Right.

987
01:10:10,560 --> 01:10:12,880
Based off of their own individual needs.

988
01:10:12,880 --> 01:10:20,800
And then light intrusion, so minimizing the light again, and then optimizing that wake

989
01:10:20,800 --> 01:10:23,040
up signal.

990
01:10:23,040 --> 01:10:29,640
So is it beneficial to just scare the heck out of somebody, you know, to get the move

991
01:10:29,640 --> 01:10:30,640
in?

992
01:10:30,640 --> 01:10:32,760
Well, you certainly want to get the move in.

993
01:10:32,760 --> 01:10:33,760
Right.

994
01:10:33,760 --> 01:10:39,000
But accelerating the heart rate like that and causing kind of sympathetic nervous system

995
01:10:39,000 --> 01:10:43,960
response is probably something we want to try to avoid.

996
01:10:43,960 --> 01:10:49,260
And I'm not sure what the answer is to this, but ways in which we can get folks awake and

997
01:10:49,260 --> 01:10:53,240
moving without sort of engaging that sympathetic nervous system strongly.

998
01:10:53,240 --> 01:10:59,840
And this is all without data, of course, you know, this is all me just, you know, hypothetically

999
01:10:59,840 --> 01:11:04,440
assessing the situation here and based off of a lot of feedback from a lot of firefighters

1000
01:11:04,440 --> 01:11:05,920
over the years.

1001
01:11:05,920 --> 01:11:09,120
But that's one area that we could we could change.

1002
01:11:09,120 --> 01:11:11,880
And then finally, I'll stop and give it to Alison.

1003
01:11:11,880 --> 01:11:16,560
But at the home, the level of the home environment, it's making sure people are getting high quality

1004
01:11:16,560 --> 01:11:19,660
education training and education on their sleep.

1005
01:11:19,660 --> 01:11:20,660
How do you prioritize?

1006
01:11:20,660 --> 01:11:22,760
It's always going to compete with other priorities.

1007
01:11:22,760 --> 01:11:23,760
Right.

1008
01:11:23,760 --> 01:11:25,080
So what can you do to prioritize it?

1009
01:11:25,080 --> 01:11:27,280
Let's say you have one night to prioritize it.

1010
01:11:27,280 --> 01:11:28,440
What do you need to consider?

1011
01:11:28,440 --> 01:11:32,200
Because everything you do from the moment you wake up until the moment you hit that bed

1012
01:11:32,200 --> 01:11:35,400
has the potential to impact your sleep positively or negatively.

1013
01:11:35,400 --> 01:11:41,160
So giving people the tools to understand how to prioritize their sleep by making better

1014
01:11:41,160 --> 01:11:45,960
decisions that will help improve their sleep, not take away their sleep quality.

1015
01:11:45,960 --> 01:11:47,100
That's great.

1016
01:11:47,100 --> 01:11:51,520
And also giving them training education on how to manage stress, because that is a huge

1017
01:11:51,520 --> 01:11:52,520
one.

1018
01:11:52,520 --> 01:11:54,600
So how do you stop a ruminating mind?

1019
01:11:54,600 --> 01:12:02,440
How do you lower that central nervous system heart rate signal yoga, breathing exercise,

1020
01:12:02,440 --> 01:12:04,560
all the things that we talked about in the past.

1021
01:12:04,560 --> 01:12:10,680
But making sure people have access to that information and it's understood so that they

1022
01:12:10,680 --> 01:12:13,320
can apply it to their own lives is key.

1023
01:12:13,320 --> 01:12:16,720
And that's what we'll turn it over to Alison.

1024
01:12:16,720 --> 01:12:24,200
Well, I think, you know, if we were queens for the day, we would have the same strategy.

1025
01:12:24,200 --> 01:12:26,080
We are twins.

1026
01:12:26,080 --> 01:12:28,080
We are twins.

1027
01:12:28,080 --> 01:12:30,240
We are queens.

1028
01:12:30,240 --> 01:12:35,960
I mean, I think the the last thing I'll add to all of that wonderful information is structure.

1029
01:12:35,960 --> 01:12:36,960
Right.

1030
01:12:36,960 --> 01:12:41,920
We, you know, we've done studies in the past with elite teams who've won national championships.

1031
01:12:41,920 --> 01:12:47,640
And we find that when we can control their schedule, because at the end of the day, I

1032
01:12:47,640 --> 01:12:51,800
think, you know, firefighters, military athletes, like you want to be told what to do.

1033
01:12:51,800 --> 01:12:53,200
You know, that's I loved about competing.

1034
01:12:53,200 --> 01:12:54,960
It's like I didn't have to think for myself.

1035
01:12:54,960 --> 01:13:01,320
I had my schedule set and we have that innate discipline that you want to be told what to

1036
01:13:01,320 --> 01:13:07,040
do is, you know, creating a culture and environment where you more or less have like a team captain.

1037
01:13:07,040 --> 01:13:11,400
I'm not saying like the captain of the fire station is someone who dictates this, but

1038
01:13:11,400 --> 01:13:19,400
that, you know, sort of informal, informal alpha female or alpha male that, you know,

1039
01:13:19,400 --> 01:13:22,320
everyone respects and looks up to is being like, hey, we're going to do this now.

1040
01:13:22,320 --> 01:13:24,160
We're going to do that now.

1041
01:13:24,160 --> 01:13:27,960
And that's something that we've seen specifically on like human performance optimization and

1042
01:13:27,960 --> 01:13:30,200
holding people accountable away from work.

1043
01:13:30,200 --> 01:13:35,080
Because that's one thing we found with these athletes, like when they were held accountable

1044
01:13:35,080 --> 01:13:41,520
and when they had structure, they slept great.

1045
01:13:41,520 --> 01:13:45,560
And when they didn't have structure during the academic year, they slept like crap.

1046
01:13:45,560 --> 01:13:49,040
So it's, it's really as simple as that.

1047
01:13:49,040 --> 01:13:50,040
Beautiful.

1048
01:13:50,040 --> 01:13:55,360
Rachel, I had a guy, Nick Littlehales on the show years ago, years and years ago, but he

1049
01:13:55,360 --> 01:13:57,200
worked with elite sports teams.

1050
01:13:57,200 --> 01:13:59,520
He's out of the UK.

1051
01:13:59,520 --> 01:14:04,240
And his specialty was he came from being a mattress salesman and he created bedding for

1052
01:14:04,240 --> 01:14:06,240
each and every athlete.

1053
01:14:06,240 --> 01:14:09,680
So I don't know if you've ever connected with him before with the mattress conversation.

1054
01:14:09,680 --> 01:14:12,680
It might be an interesting person to chat to.

1055
01:14:12,680 --> 01:14:15,680
I would love, can you make an introduction over?

1056
01:14:15,680 --> 01:14:16,680
Absolutely.

1057
01:14:16,680 --> 01:14:17,680
100%.

1058
01:14:17,680 --> 01:14:18,680
Thank you.

1059
01:14:18,680 --> 01:14:19,680
No problem.

1060
01:14:19,680 --> 01:14:20,680
I want to be mindful of the time.

1061
01:14:20,680 --> 01:14:23,240
I know you guys have got to shoot off, but I just want to say thank you so much.

1062
01:14:23,240 --> 01:14:26,920
I mean, obviously, like I said, we've done full episodes together before, so I urge people

1063
01:14:26,920 --> 01:14:32,880
to listen to those, but just kind of recapping all this information and reframing it to the

1064
01:14:32,880 --> 01:14:37,680
importance of sleep, the detrimental side when it comes to obviously mistakes and performance.

1065
01:14:37,680 --> 01:14:42,560
And obviously then the kind of ripple effect on the financial element, it just adds another

1066
01:14:42,560 --> 01:14:48,060
kind of layer to this, this argument of people just having the courage to look at this proactive

1067
01:14:48,060 --> 01:14:54,160
movement that we're seeing now and turn the ship around to use a Navy term, you know,

1068
01:14:54,160 --> 01:14:56,560
and be the hero, be the person that people can see.

1069
01:14:56,560 --> 01:14:57,560
Yeah.

1070
01:14:57,560 --> 01:15:01,720
You turned this around and now we're doing well and we're not going to as many funerals,

1071
01:15:01,720 --> 01:15:04,820
you know, and we're thriving now and we're performing at a higher level.

1072
01:15:04,820 --> 01:15:09,120
So I want to thank you both so, so much for being so generous with your time and coming

1073
01:15:09,120 --> 01:15:10,840
on the Behind the Shield podcast today.

1074
01:15:10,840 --> 01:15:11,840
Oh yeah.

1075
01:15:11,840 --> 01:15:12,840
It's going to be better.

1076
01:15:12,840 --> 01:15:13,840
Yeah.

1077
01:15:13,840 --> 01:15:14,840
Thank you, James.

1078
01:15:14,840 --> 01:15:19,960
Absolutely my foot.