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And if you want to learn more about 5 00:03:50.889 --> 00:03:53.409 .11, their mission, their products, then listen 00:03:53.409 --> 00:03:56.590 to episode 338 of the Behind the Shield podcast 00:03:56.590 --> 00:04:00.569 with the CEO and founder, Francisco Morales. 00:04:01.770 --> 00:04:03.830 Welcome to the Behind the Shield podcast. As 00:04:03.830 --> 00:04:05.650 always, my name is James Gearing, and this week 00:04:05.650 --> 00:04:07.689 it is my absolute honor to welcome on the show 00:04:07.689 --> 00:04:12.250 Professor Russell Foster. Now, one of the main 00:04:12.250 --> 00:04:15.330 reasons I started this podcast six years ago 00:04:15.330 --> 00:04:18.110 was after I started learning about sleep medicine 00:04:18.110 --> 00:04:22.370 and the incredible ill effects mentally and physically 00:04:22.370 --> 00:04:26.029 through sleep deprivation. So six years later, 00:04:26.069 --> 00:04:28.689 I get to sit down with Russell, one of the pioneers 00:04:28.689 --> 00:04:32.410 in circadian and sleep medicine. So we discuss 00:04:32.410 --> 00:04:35.850 a host of topics from his journey through zoology 00:04:35.850 --> 00:04:38.889 into sleep medicine, how sleep deprivation is 00:04:38.889 --> 00:04:41.889 causing mental health issues, cancer, obesity, 00:04:42.389 --> 00:04:45.509 hormonal disruption, how we can improve the physical 00:04:45.509 --> 00:04:48.829 and mental health in our shift workers, and so 00:04:48.829 --> 00:04:51.569 much more. Now, before we get to this incredible 00:04:51.569 --> 00:04:54.480 conversation, as I say every single week, please 00:04:54.480 --> 00:04:56.579 just take a moment, go to whichever app you listen 00:04:56.579 --> 00:04:59.879 to this on, subscribe to the show, leave feedback, 00:05:00.120 --> 00:05:03.660 and leave a rating. Every five -star rating truly 00:05:03.660 --> 00:05:06.399 does elevate this podcast, therefore making it 00:05:06.399 --> 00:05:09.800 easier for others to find. And this is a free 00:05:09.800 --> 00:05:13.899 library for you, planet Earth. So all I ask in 00:05:13.899 --> 00:05:16.480 return is that you help share these incredible 00:05:16.480 --> 00:05:19.160 men and women's stories so I can get them to 00:05:19.160 --> 00:05:22.540 every single person who needs to hear them. So 00:05:22.540 --> 00:05:25.720 with that being said, I introduce to you Professor 00:05:25.720 --> 00:05:48.069 Russell Foster. Enjoy. Well, Professor Foster, 00:05:48.209 --> 00:05:50.430 I'd love to start by saying thank you so much 00:05:50.430 --> 00:05:52.589 for taking the time and coming on the Behind 00:05:52.589 --> 00:05:55.430 the Shield podcast today. I'm really delighted 00:05:55.430 --> 00:05:59.000 to join you, James. So as an icebreaker. The 00:05:59.000 --> 00:06:01.600 reason I know about your work, there's a few 00:06:01.600 --> 00:06:04.680 kind of figures in this kind of space. Professor 00:06:04.680 --> 00:06:07.480 Andrew Huberman is definitely one of the voices 00:06:07.480 --> 00:06:11.120 we hear a lot in this area. But my dad was the 00:06:11.120 --> 00:06:13.899 one who educated me on you and your work. And 00:06:13.899 --> 00:06:15.980 then since listening, you know, it's absolutely 00:06:15.980 --> 00:06:18.660 fascinated me. Sleep has been such an important 00:06:18.660 --> 00:06:22.100 topic in my profession. So just starting, how 00:06:22.100 --> 00:06:24.699 did you meet my dad and what was the work you 00:06:24.699 --> 00:06:26.279 were doing in Imperial College at that time? 00:06:26.750 --> 00:06:28.529 Well, the first point, of course, is that it's 00:06:28.529 --> 00:06:30.410 a good example of why you should always listen 00:06:30.410 --> 00:06:33.550 to your father. Absolutely. He was actually even 00:06:33.550 --> 00:06:37.949 on the podcast. We were we were colleagues at 00:06:37.949 --> 00:06:41.790 Imperial College in London, and I was at the 00:06:41.790 --> 00:06:45.009 University of Virginia for eight years. And we 00:06:45.009 --> 00:06:47.870 had three children who were born in the States. 00:06:48.350 --> 00:06:52.959 But my wife. She's a lawyer and it was tricky 00:06:52.959 --> 00:06:57.300 to find a good slot for her to get back into 00:06:57.300 --> 00:07:00.220 work. So one of the reasons we came home was 00:07:00.220 --> 00:07:02.939 essentially to get her career, which had been 00:07:02.939 --> 00:07:08.060 on hold, kickstarted again. And I joined originally 00:07:08.060 --> 00:07:11.100 the biology department in Imperial College because 00:07:11.100 --> 00:07:14.160 my background is zoology and comparative biology. 00:07:17.220 --> 00:07:19.759 and then was offered a job at the Institute of 00:07:19.759 --> 00:07:23.040 Ophthalmology. And somebody in the medical school 00:07:23.040 --> 00:07:26.399 said to me, hang on, don't sign anything until 00:07:26.399 --> 00:07:29.839 Monday. And then they offered me a very nice 00:07:29.839 --> 00:07:31.680 job. In fact, they almost doubled my salary. 00:07:31.800 --> 00:07:34.959 It's always good to work for medical departments 00:07:34.959 --> 00:07:37.199 rather than departments of biology, because the 00:07:37.199 --> 00:07:42.360 medics get paid a lot more. And so my eyes popped 00:07:42.360 --> 00:07:46.160 out on Storks, but I'm a reasonable poker player, 00:07:46.279 --> 00:07:50.899 so I kept cool about it and moved to the medical 00:07:50.899 --> 00:07:55.600 school and set up a small department of molecular 00:07:55.600 --> 00:07:58.220 neuroscience and we were then integrating some 00:07:58.220 --> 00:08:01.000 of these wonderful discoveries being made in 00:08:01.000 --> 00:08:02.740 the neurosciences some of these new techniques 00:08:02.740 --> 00:08:07.620 and so really was was pushing hard on how is 00:08:07.620 --> 00:08:11.000 the internal biological clock producing these 00:08:11.000 --> 00:08:14.100 sort of beautiful 24 -hour circadian rhythms 00:08:15.709 --> 00:08:18.529 How is it set by the external world? It's fine 00:08:18.529 --> 00:08:20.850 having a clock, which we can use to fine -tune 00:08:20.850 --> 00:08:23.089 physiology and behavior, sort of anticipating 00:08:23.089 --> 00:08:26.329 the varied demands of the rest activity, the 00:08:26.329 --> 00:08:29.290 day -night cycle. But unless it's locked on to 00:08:29.290 --> 00:08:32.570 the external world, it's of no value at all. 00:08:32.629 --> 00:08:36.129 A classic mismatch would be jet lag, where the 00:08:36.129 --> 00:08:38.490 internal day is completely misaligned to the 00:08:38.490 --> 00:08:41.149 external day. And we knew that light was critically 00:08:41.149 --> 00:08:44.820 important at setting the internal clock. And 00:08:44.820 --> 00:08:47.500 the question that we were addressing, and it 00:08:47.500 --> 00:08:50.559 was really an incredibly productive period of 00:08:50.559 --> 00:08:55.240 time at Imperial, was how can the visual cells 00:08:55.240 --> 00:08:57.919 do this? Because what the visual cells do is 00:08:57.919 --> 00:09:01.740 grab light for our sense of space and in a sense 00:09:01.740 --> 00:09:03.840 forget they've seen light in a fraction of a 00:09:03.840 --> 00:09:07.559 second. And it never made sense to me how... 00:09:08.830 --> 00:09:11.009 Those visual cells, the rods and cones, could 00:09:11.009 --> 00:09:13.990 also be used for the detection of the dawn -dusk 00:09:13.990 --> 00:09:16.830 cycle for the regulation of internal time. Because 00:09:16.830 --> 00:09:20.409 you need to detect that light over long periods 00:09:20.409 --> 00:09:23.070 of time, and it needs to be quite bright. And 00:09:23.070 --> 00:09:27.049 so it never really could understand. So we did 00:09:27.049 --> 00:09:29.710 some experiments using mice with hereditary retinal 00:09:29.710 --> 00:09:32.389 disorders, mice that were visually blind because 00:09:32.389 --> 00:09:34.490 they had genetic diseases where their rods and 00:09:34.490 --> 00:09:38.179 cones had broken down. but they could regulate 00:09:38.179 --> 00:09:41.360 their clock absolutely perfectly. It's not only 00:09:41.360 --> 00:09:43.399 they could just do it, they did it with the same 00:09:43.399 --> 00:09:47.539 sensitivity as normal mice, you know, with their 00:09:47.539 --> 00:09:49.919 rods and cones. And when we cover the eyes, this 00:09:49.919 --> 00:09:52.500 ability to regulate the clock by light had gone. 00:09:52.899 --> 00:09:56.919 So it sort of led to the conclusion there must 00:09:56.919 --> 00:09:59.200 be something else within the eye. There must 00:09:59.200 --> 00:10:03.740 be another light sensor within the eye. And when 00:10:03.740 --> 00:10:06.309 we first... published some of these data when 00:10:06.309 --> 00:10:08.269 we were first of all we it was very difficult 00:10:08.269 --> 00:10:10.230 to publish these data because people just didn't 00:10:10.230 --> 00:10:13.990 believe it um and i remember giving a talk uh 00:10:13.990 --> 00:10:16.350 actually in the states at one of the big vision 00:10:16.350 --> 00:10:19.289 meetings and saying these data you know these 00:10:19.289 --> 00:10:22.210 rodless countless mice are consistent with the 00:10:22.210 --> 00:10:24.029 fact there must be another light sensor within 00:10:24.029 --> 00:10:27.259 the eye And some chap at the back of the auditorium 00:10:27.259 --> 00:10:29.340 stood up and looked at me, and I thought he was 00:10:29.340 --> 00:10:31.759 going to ask a question. And he just said, bullshit, 00:10:31.899 --> 00:10:37.559 and walked out. So, yeah, it took us about 10 00:10:37.559 --> 00:10:41.460 years to convince the community, the vision community, 00:10:41.860 --> 00:10:44.440 that there was something else really exciting 00:10:44.440 --> 00:10:48.419 going on in the eye. And, yeah, it was an interesting 00:10:48.419 --> 00:10:51.870 time. I mean, we had... We had some terrible 00:10:51.870 --> 00:10:55.610 setbacks. I mean, I had one grant that we submitted 00:10:55.610 --> 00:10:58.610 to the Eye Institute. In fact, this was stuff 00:10:58.610 --> 00:11:01.750 actually at the transition between coming from 00:11:01.750 --> 00:11:05.570 the States to the UK. And it was completely destroyed, 00:11:05.769 --> 00:11:10.429 absolutely destroyed. And my chairman, Mike Menneker 00:11:10.429 --> 00:11:13.169 at University of Virginia, called me into his 00:11:13.169 --> 00:11:16.899 office. And I thought, oh, gosh, you know, I'm 00:11:16.899 --> 00:11:18.700 going to get a dressing down now. This is kind 00:11:18.700 --> 00:11:22.039 of the end of my career. You know, my grant application 00:11:22.039 --> 00:11:24.799 has failed. And he said, no, you're right. This 00:11:24.799 --> 00:11:28.039 is great stuff. It's great data. Send it to another 00:11:28.039 --> 00:11:32.179 part of the funding body. So I sent it to NIMH. 00:11:32.600 --> 00:11:36.820 Six months later or so, I got a call saying, 00:11:37.000 --> 00:11:39.159 congratulations, Dr. Foster, your grant has come 00:11:39.159 --> 00:11:42.340 top of the panel. And I basically had made no 00:11:42.340 --> 00:11:44.899 changes to it. It's the same grant. that was 00:11:44.899 --> 00:11:47.679 kicked out into the outer darkness with the Eye 00:11:47.679 --> 00:11:52.259 Institute. And they said, would you mind if we 00:11:52.259 --> 00:11:54.919 copied this grant and took it to the Society 00:11:54.919 --> 00:11:57.940 for Neuroscience meeting as an example of how 00:11:57.940 --> 00:12:00.720 a research grant should be written? And it was 00:12:00.720 --> 00:12:03.840 a really important lesson to have sort of had 00:12:03.840 --> 00:12:07.659 in my early career, where basically you keep 00:12:07.659 --> 00:12:10.360 on kicking the door until the bug has let you 00:12:10.360 --> 00:12:13.899 in. And it was that. I mean, it's often sort 00:12:13.899 --> 00:12:16.480 of caricatured as a can -do attitude in the United 00:12:16.480 --> 00:12:20.080 States, but it is. And I think it was that spirit 00:12:20.080 --> 00:12:24.759 of just, you know, just not being knocked back 00:12:24.759 --> 00:12:27.399 and not taking no for an answer, which was a 00:12:27.399 --> 00:12:31.419 very, very important lesson. So, yeah, and then 00:12:31.419 --> 00:12:34.519 continued with the work at Imperial College. 00:12:34.799 --> 00:12:38.970 And it's just sort of... carried on, you know, 00:12:38.970 --> 00:12:41.830 starting with mice, then humans, and now working 00:12:41.830 --> 00:12:44.809 on drugs, which I guess we can talk about later, 00:12:44.929 --> 00:12:48.529 on how to thaw the clock that it's seen light 00:12:48.529 --> 00:12:52.090 for people who don't have eyes. Well, I want 00:12:52.090 --> 00:12:53.690 to go to the beginning of your timeline, but 00:12:53.690 --> 00:12:55.330 just before I do, when you're talking about door 00:12:55.330 --> 00:12:59.149 kicking, that was something that I found, really, 00:12:59.309 --> 00:13:01.970 the creation of this podcast was founded out 00:13:01.970 --> 00:13:06.889 of that absolute death grip onto the way we've 00:13:06.889 --> 00:13:09.450 always done it before and so as we touched on 00:13:09.450 --> 00:13:12.309 before we started recording as things are starting 00:13:12.309 --> 00:13:15.009 to open up with the cancer in the first responder 00:13:15.009 --> 00:13:17.629 community there's this death grip on carcinogens 00:13:17.629 --> 00:13:19.570 and absolutely that's that's a part of it when 00:13:19.570 --> 00:13:21.210 we look at the mental health side there's a death 00:13:21.210 --> 00:13:24.850 grip on it's a trauma that we see obesity I mean 00:13:24.850 --> 00:13:26.289 all these things that we'll probably unpack in 00:13:26.289 --> 00:13:30.070 a bit but And it's been hard because the fire 00:13:30.070 --> 00:13:33.789 service, even more so than in the UK, is very, 00:13:33.850 --> 00:13:35.590 very siloed. You could have, you know, a city 00:13:35.590 --> 00:13:37.370 and a county and those two departments won't 00:13:37.370 --> 00:13:39.370 even talk to each other. And then, you know, 00:13:39.370 --> 00:13:43.169 the network of the country is the same. So when 00:13:43.169 --> 00:13:46.129 you are being ridiculed by some of your community, 00:13:46.269 --> 00:13:49.509 being told, well, rods are, you know, for black 00:13:49.509 --> 00:13:51.269 and white and cones of a color and that's it. 00:13:53.850 --> 00:13:55.889 How did you, I mean, you know, kicking the door 00:13:55.889 --> 00:13:58.549 is an analogy, but how did you actually muster 00:13:58.549 --> 00:14:01.929 the strength and move the needle against such 00:14:01.929 --> 00:14:06.330 inertia in the community that you were working 00:14:06.330 --> 00:14:10.090 in? I think, first of all, it's easier when you're 00:14:10.090 --> 00:14:13.690 younger because you've got more confidence and 00:14:13.690 --> 00:14:17.629 perhaps you're a bit more arrogant. And I think 00:14:17.629 --> 00:14:21.070 that helps. But I think it's more than that. 00:14:22.779 --> 00:14:25.179 I know it's sort of caricatured, but it's a can 00:14:25.179 --> 00:14:28.580 -do attitude. I was surrounded by people who 00:14:28.580 --> 00:14:31.740 were enthusiastic. And one of the things that 00:14:31.740 --> 00:14:33.940 people said to me before I went to the States 00:14:33.940 --> 00:14:36.059 was, your problem, Russell, is you're just too 00:14:36.059 --> 00:14:39.919 enthusiastic. And when I got to the States, it 00:14:39.919 --> 00:14:43.100 was embraced. And that's how you're supposed 00:14:43.100 --> 00:14:46.120 to be. So I was pre -adapted. And I think there's 00:14:46.120 --> 00:14:52.019 a very large, unacknowledged... debt that many 00:14:52.019 --> 00:14:56.980 European scientists have to their experiences 00:14:56.980 --> 00:15:00.440 in the United States. Many of us left the UK 00:15:00.440 --> 00:15:05.720 towards the end of the 80s and discovered a new 00:15:05.720 --> 00:15:08.980 way of doing science, where enthusiasm was embraced, 00:15:09.259 --> 00:15:13.799 where can -do was driven forward. where you were 00:15:13.799 --> 00:15:18.399 expected to kick the door. And it wasn't bad. 00:15:18.539 --> 00:15:20.700 You didn't sort of curl up in the corner and 00:15:20.700 --> 00:15:23.659 sort of think, oh, well, that's it. You actually 00:15:23.659 --> 00:15:27.860 got up and you kicked the door. And so when we 00:15:27.860 --> 00:15:31.840 returned to places like the UK and other European 00:15:31.840 --> 00:15:35.019 countries, we were not prepared to stand up, 00:15:35.080 --> 00:15:37.480 not prepared to put up with the old hierarchies 00:15:37.480 --> 00:15:40.820 and the old sorts of ways of doing things. And 00:15:40.820 --> 00:15:43.789 I think... And I'm very serious about this. I 00:15:43.789 --> 00:15:46.929 think the Americans need to know what they've 00:15:46.929 --> 00:15:50.590 contributed to world science by training a cohort 00:15:50.590 --> 00:15:56.149 of individuals throughout the 80s and 90s. And 00:15:56.149 --> 00:16:00.629 they've gone back. And the health of UK science, 00:16:00.730 --> 00:16:02.809 for example, I think is very dependent on a lot 00:16:02.809 --> 00:16:06.149 of people who went away and then came back and 00:16:06.149 --> 00:16:09.539 have. put that energy that they experienced in 00:16:09.539 --> 00:16:11.200 the States into the science that we're doing 00:16:11.200 --> 00:16:16.419 here. It's a really huge contribution, which 00:16:16.419 --> 00:16:19.039 I don't think anybody really appreciates in the 00:16:19.039 --> 00:16:21.240 States. So many of us who worked in the States 00:16:21.240 --> 00:16:24.860 have great affection for not only the opportunity, 00:16:25.100 --> 00:16:29.220 but also the spirit of the country. Yeah, and 00:16:29.220 --> 00:16:31.460 I agree completely. When I moved here, I totally 00:16:31.460 --> 00:16:35.259 bought into... the American dream, but the original 00:16:35.259 --> 00:16:39.200 American dream. You come here, you forge a path 00:16:39.200 --> 00:16:41.000 in your own career. You put a roof over your 00:16:41.000 --> 00:16:43.200 family's head. Very, very simple. When I arrived 00:16:43.200 --> 00:16:45.720 here, it really was right before the big crash. 00:16:45.899 --> 00:16:48.080 So the American dream had kind of morphed into 00:16:48.080 --> 00:16:52.039 a large house, a jet ski, a Winnebago. So it 00:16:52.039 --> 00:16:54.639 was a little distorted, but I think that's it. 00:16:54.679 --> 00:16:57.259 That immigration story, that entrepreneurial 00:16:57.259 --> 00:17:01.120 spirit, that challenging the system is at the 00:17:01.120 --> 00:17:04.079 core of what I got here now the maddening thing 00:17:04.079 --> 00:17:06.380 is that's been suppressed a lot in america so 00:17:06.380 --> 00:17:09.400 it's about reigniting that fire within this country 00:17:09.400 --> 00:17:12.640 itself yes that's what i understand and it's 00:17:12.640 --> 00:17:15.920 a it's a great shame because um there are so 00:17:15.920 --> 00:17:19.519 many qualities and so much drive but i think 00:17:19.519 --> 00:17:22.440 i think again if i might speak freely i mean 00:17:22.440 --> 00:17:26.960 i i think the fundamentals of of the united states 00:17:26.960 --> 00:17:30.200 are there It may go for a wobble from time to 00:17:30.200 --> 00:17:32.559 time, but it will self -correct. And I have every 00:17:32.559 --> 00:17:37.619 expectation that those wonderful attitudes will 00:17:37.619 --> 00:17:41.539 return and there will be more of perhaps of a 00:17:41.539 --> 00:17:46.680 consensus and an appreciation of everybody contributing 00:17:46.680 --> 00:17:50.420 to the American way of life. Absolutely. Well, 00:17:50.480 --> 00:17:52.059 I'd love to start at the very beginning. I know, 00:17:52.140 --> 00:17:54.740 you know, some of your journey as far as higher 00:17:54.740 --> 00:17:57.180 education, but tell me where you were born and 00:17:57.180 --> 00:17:58.640 tell me a little bit about your family dynamic, 00:17:58.799 --> 00:18:00.380 what your parents did and how many siblings. 00:18:00.980 --> 00:18:04.599 That's interesting. So I was born in a town called 00:18:04.599 --> 00:18:07.440 Aldershot, which is in Hampshire. And Aldershot 00:18:07.440 --> 00:18:10.740 is known as the home of the British Army. And 00:18:10.740 --> 00:18:15.619 the reason was that my mother had. gone through 00:18:15.619 --> 00:18:17.799 the ranks of being a nurse and then a matron 00:18:17.799 --> 00:18:22.539 and then was invited to take charge of a home 00:18:22.539 --> 00:18:26.740 for socially deprived children preschool so these 00:18:26.740 --> 00:18:30.019 are these are kids who were no older than six 00:18:30.019 --> 00:18:32.660 between you know and some of them much younger 00:18:32.660 --> 00:18:35.480 and so grew up in an environment where there 00:18:35.480 --> 00:18:38.599 were children from a very difficult family background 00:18:38.599 --> 00:18:41.680 or may have some physical or mental handicaps. 00:18:41.700 --> 00:18:44.640 And they were looked after by mum and obviously 00:18:44.640 --> 00:18:48.440 a large number of staff in this huge, great old 00:18:48.440 --> 00:18:53.519 Victorian house. And so that was what my mum 00:18:53.519 --> 00:18:57.299 did. My father was in charge of the pathology 00:18:57.299 --> 00:19:00.119 laboratories at British Airways, BOEC as it was 00:19:00.119 --> 00:19:03.460 then. So there was always sort of kind of... 00:19:03.789 --> 00:19:07.390 vaguely biomedical stuff my father was was a 00:19:07.390 --> 00:19:11.190 really great pathologist so he would prepare 00:19:11.190 --> 00:19:14.069 lots of specimens and microscopes featured large 00:19:14.069 --> 00:19:17.720 and in fact a very I must have picked this up 00:19:17.720 --> 00:19:21.940 from him because I desperately, just desperately 00:19:21.940 --> 00:19:24.140 wanted my own microscope as a very young kid. 00:19:24.480 --> 00:19:26.500 And I think like all of us, we get these little 00:19:26.500 --> 00:19:29.720 cast iron microscopes, tiny little thing. And 00:19:29.720 --> 00:19:32.960 I remember being very frustrated that when I 00:19:32.960 --> 00:19:34.819 looked down at my eyelashes would get in the 00:19:34.819 --> 00:19:38.980 way. So as a pragmatist, as a probably a six 00:19:38.980 --> 00:19:41.819 or seven or maybe eight year old, I decided to 00:19:41.819 --> 00:19:45.079 cut my eyelashes off so it wouldn't get in the 00:19:45.079 --> 00:19:48.410 way. And I remember my poor old mum saying to 00:19:48.410 --> 00:19:51.210 me, what have you done to your eyelashes? And 00:19:51.210 --> 00:19:52.690 I said, I cut them off because they kept on getting 00:19:52.690 --> 00:19:54.089 in the way when I was looking down the microscope. 00:19:54.799 --> 00:19:57.000 And she was great because what she said was, 00:19:57.079 --> 00:20:00.259 well, OK, that might not have been such a smart 00:20:00.259 --> 00:20:01.960 thing to do because, of course, eyelashes are 00:20:01.960 --> 00:20:04.519 there to protect the eye from things falling 00:20:04.519 --> 00:20:08.180 in. So I'd rather you didn't do that again. So 00:20:08.180 --> 00:20:11.460 rather than getting shouted at, it was a very 00:20:11.460 --> 00:20:13.000 good strategy because she'd already worked out 00:20:13.000 --> 00:20:15.779 that if somebody shouts at me or tells me to 00:20:15.779 --> 00:20:18.380 do something, then I will do the opposite. But 00:20:18.380 --> 00:20:22.940 she was very reasonable and it was a very sound. 00:20:23.849 --> 00:20:26.789 And so I completely complied. I've never since 00:20:26.789 --> 00:20:30.670 cut my eyelashes off. I can literally see what 00:20:30.670 --> 00:20:32.210 you're talking about, too, because I had a microscope 00:20:32.210 --> 00:20:34.410 and it was the same thing. There were spiders 00:20:34.410 --> 00:20:36.769 everywhere. It was actually my own eyes. And, 00:20:37.089 --> 00:20:39.210 you know, you couldn't see that fly proboscis 00:20:39.210 --> 00:20:41.630 or B -wing or whatever the slides that we all 00:20:41.630 --> 00:20:45.410 looked at as kids. So that was that. But my father 00:20:45.410 --> 00:20:52.079 left when I was 11. So complicated times. And 00:20:52.079 --> 00:20:56.119 I think as children, one of the protective mechanisms 00:20:56.119 --> 00:20:59.220 is to see the world in black and white. And so 00:20:59.220 --> 00:21:03.940 basically, I then refused to see my father again. 00:21:04.079 --> 00:21:06.960 So never saw him until, you know, and he died 00:21:06.960 --> 00:21:10.099 when I was doing my PhD. So it was that sort 00:21:10.099 --> 00:21:13.599 of big sort of schism in my early childhood. 00:21:15.419 --> 00:21:17.980 I was lucky because I had the most extraordinary 00:21:17.980 --> 00:21:20.539 grandparents. And so in a sense, I'd always been 00:21:20.539 --> 00:21:24.380 close to them. But they provided an incredible 00:21:24.380 --> 00:21:29.559 sense of stability and nurturing. And I mean, 00:21:29.599 --> 00:21:32.500 it was remedial. You know, I was in remedial 00:21:32.500 --> 00:21:34.279 classes at school. I just lived in my own little 00:21:34.279 --> 00:21:36.880 world, my little bubble, looking down my microscopes, 00:21:36.880 --> 00:21:38.460 you know, collecting fossils, all that sort of 00:21:38.460 --> 00:21:41.180 thing. And I was a good swimmer, really good 00:21:41.180 --> 00:21:45.440 swimmer. And so I remember. uh winning i know 00:21:45.440 --> 00:21:47.779 i was the captain of the school for the swimming 00:21:47.779 --> 00:21:50.400 team and you know just won this gala and the 00:21:50.400 --> 00:21:53.460 headmaster came up and said um of course you 00:21:53.460 --> 00:21:55.839 do realize russell is an entirely non -academic 00:21:55.839 --> 00:22:00.019 child um and uh but my dear old gran she always 00:22:00.019 --> 00:22:02.940 sort of no no he's he's he's all right you know 00:22:02.940 --> 00:22:05.500 he's bright enough so don't worry about it and 00:22:05.500 --> 00:22:08.480 of course um that was one could be more relaxed 00:22:08.480 --> 00:22:10.039 i guess in those days because we weren't sort 00:22:10.039 --> 00:22:13.240 of constantly being driven forward over the next 00:22:13.240 --> 00:22:17.380 hurdle. So there was time to sort of, I guess, 00:22:17.480 --> 00:22:20.319 regroup. And there was time to catch up. And 00:22:20.319 --> 00:22:22.480 so I went from the bottom of the class to the 00:22:22.480 --> 00:22:24.920 top of the class within 18 months. Completely 00:22:24.920 --> 00:22:28.640 bizarre. Really fascinating. So, yeah, I mean, 00:22:28.680 --> 00:22:31.119 I had that love. Although my parents split up, 00:22:31.240 --> 00:22:34.380 I was lucky to have that support from my grandparents, 00:22:34.619 --> 00:22:39.849 who I was very close to. And so I had that. And 00:22:39.849 --> 00:22:42.009 I know very many people can be terribly affected 00:22:42.009 --> 00:22:43.930 by their parents splitting up. It didn't I don't 00:22:43.930 --> 00:22:46.269 think had a huge effect on me because I had that 00:22:46.269 --> 00:22:50.549 that huge cushioning as well. So, yeah. And then 00:22:50.549 --> 00:22:53.730 I went to university and University of Bristol. 00:22:54.069 --> 00:22:59.369 And it was so exciting because I then really 00:22:59.369 --> 00:23:01.769 met for the first time lots of other nerdy people 00:23:01.769 --> 00:23:05.460 like myself. And, you know, it's it's. Part of 00:23:05.460 --> 00:23:07.380 the excitement of university, there are many 00:23:07.380 --> 00:23:09.599 things, but one of the things is that you can 00:23:09.599 --> 00:23:11.359 stay up until the early hours of the morning 00:23:11.359 --> 00:23:15.059 just chatting about stuff and things that matter. 00:23:15.859 --> 00:23:21.140 And so it was a wonderful time and just got more 00:23:21.140 --> 00:23:24.140 and more. I did zoology, so just immersed myself 00:23:24.140 --> 00:23:29.460 in the world of biology and then did my PhD in 00:23:29.460 --> 00:23:32.180 Bristol and then got the opportunity to do a 00:23:32.180 --> 00:23:35.130 little bit of postdocing, but I stayed. I stayed 00:23:35.130 --> 00:23:37.490 in Bristol, but actually I spent most of my time 00:23:37.490 --> 00:23:40.950 in Holland learning photoreceptor, like, you 00:23:40.950 --> 00:23:44.609 know, biochemistry and Germany learning anatomy. 00:23:44.910 --> 00:23:47.710 And that was, again, a really formative experience 00:23:47.710 --> 00:23:50.410 because you go to another place and you see another 00:23:50.410 --> 00:23:53.829 way of doing science. And that sort of, I mean, 00:23:53.849 --> 00:23:57.509 I had an extremely rigorous training. It was 00:23:57.509 --> 00:24:02.349 pretty brutal. I mean, and my supervisor and 00:24:02.349 --> 00:24:05.839 I now. get on incredibly well. I mean, he's been 00:24:05.839 --> 00:24:08.140 amazingly supportive throughout my career without 00:24:08.140 --> 00:24:11.279 me knowing it half the time. But there were occasions 00:24:11.279 --> 00:24:15.299 where we did have some clashes and I won't go 00:24:15.299 --> 00:24:19.839 into any particular detail, but we did. And it 00:24:19.839 --> 00:24:22.460 was very useful. But part of the reason was he 00:24:22.460 --> 00:24:27.579 was just very, very rigorous and would, I remember 00:24:27.579 --> 00:24:32.380 when I gave him my first draft of my PhD. thesis. 00:24:32.640 --> 00:24:36.119 And Rumi's quite old school. And so it was a 00:24:36.119 --> 00:24:37.960 draft. And I thought, well, it's kind of a draft. 00:24:38.160 --> 00:24:41.380 And he read this and he said, this is the worst 00:24:41.380 --> 00:24:45.099 draft of a PhD thesis I have ever read. It is 00:24:45.099 --> 00:24:52.779 even worse than the foreign students. And that 00:24:52.779 --> 00:24:55.539 was sort of quite a confidence knock. But then 00:24:55.539 --> 00:24:58.299 it was very interesting because another person, 00:24:58.339 --> 00:25:00.900 another very good scientist read it and said, 00:25:00.940 --> 00:25:04.630 this is great. And in fact, the changes were 00:25:04.630 --> 00:25:07.529 that he was well, because basically I didn't 00:25:07.529 --> 00:25:09.809 write like he wrote. And so he would rewrite 00:25:09.809 --> 00:25:12.690 in his style. And that was another great lesson, 00:25:12.809 --> 00:25:15.609 because with with with my team and I'm given 00:25:15.609 --> 00:25:19.589 a paper, my first temptation is to rewrite it 00:25:19.589 --> 00:25:23.869 in my style. But that's wrong. Basically, as 00:25:23.869 --> 00:25:25.950 long as it's coherent and long as it's well structured, 00:25:26.069 --> 00:25:29.890 you don't have to have. the same phraseology 00:25:29.890 --> 00:25:33.650 or the same sorts of, it can be different. And 00:25:33.650 --> 00:25:36.509 so, yeah, that was a good lesson. But anyway, 00:25:36.670 --> 00:25:40.390 and then after, and then we had a visitor from 00:25:40.390 --> 00:25:43.490 the States, Mike Menica, and we got on really 00:25:43.490 --> 00:25:46.390 well. I mean, he was just, he and his wife, Shirley, 00:25:46.569 --> 00:25:50.829 both sadly dead now. And he said, why don't you 00:25:50.829 --> 00:25:53.630 come over to the States? You know, so I went 00:25:53.630 --> 00:25:56.789 over for three months at the end of 87. And it 00:25:56.789 --> 00:26:00.289 was just amazing. The generosity. I mean, they 00:26:00.289 --> 00:26:04.210 had a car and called Pigweed. And they said, 00:26:04.269 --> 00:26:06.509 look, you know, you can use Pigweed. And I stayed 00:26:06.509 --> 00:26:10.089 in that place. And it was it was just amazing. 00:26:10.329 --> 00:26:11.970 So he said, well, why don't you come back, you 00:26:11.970 --> 00:26:15.390 know, become an assistant professor. So got back 00:26:15.390 --> 00:26:19.630 and went to university, went to University of 00:26:19.630 --> 00:26:22.750 Virginia and spent eight very happy years there 00:26:22.750 --> 00:26:26.170 doing a lot of teaching. I learnt. um a great 00:26:26.170 --> 00:26:29.109 deal about teaching and my class which was intro 00:26:29.109 --> 00:26:33.450 biology 202 um went from 200 students to 700 00:26:33.450 --> 00:26:36.450 students i mean we just just exploded and it 00:26:36.450 --> 00:26:38.849 was great i mean these are fantastic kids i had 00:26:38.849 --> 00:26:42.650 i had a great time um and uh then we came back 00:26:42.650 --> 00:26:46.710 to imperial college um first of all biology and 00:26:46.710 --> 00:26:51.720 uh then try to get all my stuff funded which 00:26:51.720 --> 00:26:53.619 had previously been funded in the States. And 00:26:53.619 --> 00:26:55.759 it just kept on hitting the deck. Very interestingly, 00:26:55.940 --> 00:26:58.900 incidentally, I wrote, I hope I'm not going to 00:26:58.900 --> 00:27:01.960 get anybody into trouble, but I wrote to NIMH 00:27:01.960 --> 00:27:05.900 because I had a grant which couldn't leave the 00:27:05.900 --> 00:27:09.500 country. And so I wrote saying, look, I've taken 00:27:09.500 --> 00:27:12.440 a job at Imperial College. I understand my R101, 00:27:12.779 --> 00:27:16.380 cannot leave. And so very regrettably, I'm going 00:27:16.380 --> 00:27:19.759 to have to return it. And I sent a fax. And then 00:27:19.759 --> 00:27:21.819 I got a call. You can tell how long ago this 00:27:21.819 --> 00:27:24.599 was. And then I got a call from this wonderful 00:27:24.599 --> 00:27:27.579 chap who I'd worked with, my project manager, 00:27:27.819 --> 00:27:30.500 and said, I've destroyed your facts. As far as 00:27:30.500 --> 00:27:32.160 I'm concerned, you have an honorary appointment 00:27:32.160 --> 00:27:34.339 at the University of Virginia, and that's where 00:27:34.339 --> 00:27:38.039 you'll be based. And he said, we want to fund 00:27:38.039 --> 00:27:40.420 the best science there is around the world. And 00:27:40.420 --> 00:27:43.380 if you are not in the States, well, that's unfortunate, 00:27:43.599 --> 00:27:45.710 but we're not going to. take the money back. 00:27:45.890 --> 00:27:48.150 Now, actually, officially, he should have done 00:27:48.150 --> 00:27:51.079 that. But what that allowed me to do. was to 00:27:51.079 --> 00:27:53.940 keep the research going because we got the early 00:27:53.940 --> 00:27:56.279 studies in the States and then we could expand 00:27:56.279 --> 00:27:59.480 them massively and it was all the string of science 00:27:59.480 --> 00:28:02.079 and nature papers that were really came from 00:28:02.079 --> 00:28:06.380 the time of Imperial or the first crop but it 00:28:06.380 --> 00:28:09.019 was based on early findings that were made in 00:28:09.019 --> 00:28:12.039 the States so whilst I was trying to convince 00:28:12.039 --> 00:28:14.279 my UK colleagues that we discovered something 00:28:14.279 --> 00:28:17.869 important um uh and before the grant funding 00:28:17.869 --> 00:28:19.750 kicked in there i had the same exactly the same 00:28:19.750 --> 00:28:21.890 problems when i returned to the uk so i had when 00:28:21.890 --> 00:28:23.650 i was first in the states nobody believed it 00:28:23.650 --> 00:28:27.690 um but but but through this funding we kept the 00:28:27.690 --> 00:28:31.950 whole edifice on the tracks And the rest is history. 00:28:33.009 --> 00:28:36.829 So walk me through your kind of journey into 00:28:36.829 --> 00:28:40.910 chronobiology. And then when did the merger happen 00:28:40.910 --> 00:28:44.630 between circadian rhythm studies and the sleep 00:28:44.630 --> 00:28:51.470 world? Yeah. So if we go back to the undergraduate 00:28:51.470 --> 00:28:54.730 days at Bristol, there's a famous vertebrate 00:28:54.730 --> 00:28:57.970 textbook called The Life of the Vertebrates by 00:28:57.970 --> 00:29:03.609 J .Z. Young. And I was reading this, as you do, 00:29:03.710 --> 00:29:07.289 one evening. And I came across this work on the 00:29:07.289 --> 00:29:09.630 lamprey, you know, these really primitive fish 00:29:09.630 --> 00:29:14.309 -like creatures, early vertebrates. And it had 00:29:14.309 --> 00:29:18.670 a, J .C. Jung talked about this third, this parietal 00:29:18.670 --> 00:29:20.569 eye, that they actually have their lateral eyes 00:29:20.569 --> 00:29:22.430 and then a photoreceptor actually on top of their 00:29:22.430 --> 00:29:24.869 skull. I thought that was just so amazing and 00:29:24.869 --> 00:29:27.390 so cool. And I remember it was the second year, 00:29:27.430 --> 00:29:29.910 I rushed in. And then started speaking to one 00:29:29.910 --> 00:29:31.609 of the professors there and said, look, I really 00:29:31.609 --> 00:29:33.690 want to do some work on something like this. 00:29:33.910 --> 00:29:36.650 And so we set up my third year project, which 00:29:36.650 --> 00:29:40.529 was recording from these third eyes, these pineal 00:29:40.529 --> 00:29:45.430 photoreceptors. This was in frogs. And so that 00:29:45.430 --> 00:29:47.769 was just so cool, you know, because here's a 00:29:47.769 --> 00:29:51.430 structure that is not an eye, but light sensitive 00:29:51.430 --> 00:29:54.990 and regulating behavior and biology. And that. 00:29:55.440 --> 00:29:58.660 then got me into my PhD work which is how birds 00:29:58.660 --> 00:30:02.400 detect the expanding and contracting day length 00:30:02.400 --> 00:30:05.420 and use that to regulate their reproductive system 00:30:05.420 --> 00:30:08.069 so you know the increasing days of spring are 00:30:08.069 --> 00:30:11.029 detected by a weird photoreceptor in birds, believe 00:30:11.029 --> 00:30:13.730 it or not, those receptors are actually within 00:30:13.730 --> 00:30:17.809 the brain, actually near those cells that are 00:30:17.809 --> 00:30:20.529 actually activated to trigger reproduction. So 00:30:20.529 --> 00:30:22.829 you've got cells in the hypothalamus, deep in 00:30:22.829 --> 00:30:24.970 the brain, which are light sensitive. And at 00:30:24.970 --> 00:30:27.369 this point, people say, oh, come on, what are 00:30:27.369 --> 00:30:29.869 you talking about? How, you know, no light can 00:30:29.869 --> 00:30:33.049 possibly reach the brain. Well, it does. And 00:30:33.049 --> 00:30:36.150 we've all done this, illustrated this point. 00:30:36.559 --> 00:30:39.259 When kids, because you crawl under the bedclothes 00:30:39.259 --> 00:30:42.599 and you put a flashlight to your hand and your 00:30:42.599 --> 00:30:45.599 hand glows. So yes, lots of light does penetrate 00:30:45.599 --> 00:30:48.539 through tissue. It's scattered and absorbed in 00:30:48.539 --> 00:30:51.279 a way which makes it useless for vision. But 00:30:51.279 --> 00:30:54.759 as a way of detecting the dawn -dusk cycle, it's 00:30:54.759 --> 00:30:58.640 fine. So you've got local light detectors. So 00:30:58.640 --> 00:31:03.079 that was the sort of the photoreceptor, which 00:31:03.079 --> 00:31:06.400 made... When we started looking at mammals and 00:31:06.400 --> 00:31:08.500 how the hell do they do it, because we knew they 00:31:08.500 --> 00:31:11.319 didn't have extra retinal photoreceptors, because 00:31:11.319 --> 00:31:13.619 if you covered up the eyes, all light responses 00:31:13.619 --> 00:31:17.039 were gone. And in fact, mammals are very interesting. 00:31:17.240 --> 00:31:19.579 They've gone through what's called a nocturnal 00:31:19.579 --> 00:31:23.619 bottleneck. The entire mammalian lineage was 00:31:23.619 --> 00:31:27.210 once nocturnal. And so while the ruling reptiles, 00:31:27.230 --> 00:31:30.289 the archosaurs, the dinosaurs dominated the daylight 00:31:30.289 --> 00:31:33.789 environment, our ancestors were emerging at twilight 00:31:33.789 --> 00:31:36.589 from their burrows and then scuttling around. 00:31:36.769 --> 00:31:40.089 And of course, nocturnal animals don't have brilliant 00:31:40.089 --> 00:31:44.559 vision. And they also have lost extra retinal 00:31:44.559 --> 00:31:46.960 photoreceptors. So that's why mammals don't have 00:31:46.960 --> 00:31:51.660 it. So making the conceptual leap that there 00:31:51.660 --> 00:31:55.259 could be a weird photoreceptor in the eye wasn't 00:31:55.259 --> 00:31:58.119 so huge for me because I'd worked on weird photoreceptors 00:31:58.119 --> 00:32:01.299 outside the eye. Now, for vision biologists who've 00:32:01.299 --> 00:32:04.839 only studied rods and cones and visual responses, 00:32:05.299 --> 00:32:07.740 that's why it was such a heresy because they'd 00:32:07.740 --> 00:32:10.769 never looked at light responses. other than vision. 00:32:10.890 --> 00:32:12.710 And I was looking for a light response which 00:32:12.710 --> 00:32:15.269 was regulating the clock. So that was part of 00:32:15.269 --> 00:32:19.789 the... it's a great example actually where interesting 00:32:19.789 --> 00:32:22.049 discoveries emerge at the interplace between 00:32:22.049 --> 00:32:25.250 different disciplines. And if you're siloed in 00:32:25.250 --> 00:32:29.869 one particular part of science you tend not... 00:32:30.059 --> 00:32:32.720 to think more broadly. You just take a lot of 00:32:32.720 --> 00:32:36.480 facts as so -called facts, as read. You don't 00:32:36.480 --> 00:32:38.700 question it. But if you come from the outside, 00:32:38.960 --> 00:32:41.539 you tend to sort of think about things slightly 00:32:41.539 --> 00:32:44.019 differently. So again, that's why it's so important, 00:32:44.140 --> 00:32:47.220 I think, in the sciences to break down the barriers 00:32:47.220 --> 00:32:49.319 and get people in different areas talking to 00:32:49.319 --> 00:32:51.220 each other, because that's now where the exciting 00:32:51.220 --> 00:32:55.099 stuff is emerging. So I was always interested 00:32:55.099 --> 00:32:57.960 in photoreceptors, and that's why I spent a lot 00:32:57.960 --> 00:33:00.500 of my career. Then I was... When I was working 00:33:00.500 --> 00:33:02.920 at Charing Cross Hospital, which was the medical 00:33:02.920 --> 00:33:05.140 school part of Imperial College, which is where 00:33:05.140 --> 00:33:09.380 your dad was, of course, I was in an elevator 00:33:09.380 --> 00:33:13.240 with a psychiatrist and said, oh, you work on 00:33:13.240 --> 00:33:16.079 sleep, don't you? And I said, well, actually, 00:33:16.160 --> 00:33:19.279 I work on circadian rhythms. And he's sort of 00:33:19.279 --> 00:33:21.660 oblivious of the subtlety between the difference. 00:33:21.740 --> 00:33:23.880 And we'll come back to that later. He said, yeah, 00:33:23.980 --> 00:33:26.650 of course, my patients with schizophrenia. They 00:33:26.650 --> 00:33:30.029 get up late. They get to bed late. They miss 00:33:30.029 --> 00:33:32.190 my clinic and don't have friends because they 00:33:32.190 --> 00:33:35.130 don't have a job. And I thought, well, that's 00:33:35.130 --> 00:33:38.630 kind of a bit daft. And so that that irritation 00:33:38.630 --> 00:33:41.710 triggered a study, which is the one of the first 00:33:41.710 --> 00:33:44.230 studies on the sleep wake cycles and circadian 00:33:44.230 --> 00:33:47.170 rhythms of individuals of the diagnosis of schizophrenia. 00:33:47.809 --> 00:33:51.650 And that got me into human research. And and 00:33:51.650 --> 00:33:54.670 in fact. Just sort of parenthetically, those 00:33:54.670 --> 00:33:58.170 rhythms that we saw in those severe cases of 00:33:58.170 --> 00:34:00.390 mental health, the rhythms weren't just bad, 00:34:00.509 --> 00:34:02.650 they were smashed. I mean, I have never seen 00:34:02.650 --> 00:34:05.450 such disrupted sleep -wake cycles in anything 00:34:05.450 --> 00:34:08.929 else. I mean, these were profound and it made 00:34:08.929 --> 00:34:13.269 a huge impact on me. And so that started a parallel 00:34:13.269 --> 00:34:19.679 set of studies. on humans. And so now I sort 00:34:19.679 --> 00:34:26.619 of span human studies and animal studies. But 00:34:26.619 --> 00:34:30.300 you asked, so what about sleep and circadian 00:34:30.300 --> 00:34:33.920 rhythms? And so in the early days, those of us 00:34:33.920 --> 00:34:37.159 who went to circadian rhythm meetings were comparative 00:34:37.159 --> 00:34:39.480 biologists. There were people working on plants 00:34:39.480 --> 00:34:43.039 and pigeons and reptiles and maybe a few people 00:34:43.039 --> 00:34:46.909 working on mice. And we were just kind of zoologists 00:34:46.909 --> 00:34:50.530 and botanists interested in rhythmicity. We never 00:34:50.530 --> 00:34:54.530 thought about sleep. Where sleep has its origins 00:34:54.530 --> 00:34:58.250 is in medicine. And it's medics sticking electrodes 00:34:58.250 --> 00:35:01.590 onto the surface of the skin on the scalp, recording 00:35:01.590 --> 00:35:05.550 the electroencephalogram and looking at how the 00:35:05.550 --> 00:35:10.349 EEG. with different sorts of states and conditions. 00:35:10.489 --> 00:35:12.889 You have non -REM and REM sleep and all the rest 00:35:12.889 --> 00:35:14.789 of it. But we didn't go to the same meetings. 00:35:15.329 --> 00:35:18.889 But then as we had a greater understanding of 00:35:18.889 --> 00:35:21.429 the role of circadian rhythms in the regulation 00:35:21.429 --> 00:35:24.889 of sleep, and as the neuroscience of sleep became 00:35:24.889 --> 00:35:32.219 much clearer, it was... crazy to many of us to 00:35:32.219 --> 00:35:34.500 think that sleep should be considered as distinct. 00:35:34.599 --> 00:35:39.019 It's another 24 -hour phenomenon. It's complicated, 00:35:39.280 --> 00:35:43.000 but at its heart, one could argue, is the regulation 00:35:43.000 --> 00:35:46.519 by the circadian system. So now I feel comfortable 00:35:46.519 --> 00:35:48.860 working, you know, saying that I'm both a circadian 00:35:48.860 --> 00:35:51.219 and a sleep researcher. And in fact, a lot of 00:35:51.219 --> 00:35:53.019 the stuff we're doing now, going back to the 00:35:53.019 --> 00:35:55.880 animal models, we've got some really cool data 00:35:55.880 --> 00:36:00.960 on how light is regulating the fundamental mechanisms 00:36:00.960 --> 00:36:04.179 regulating sleep. So there's some cool stuff 00:36:04.179 --> 00:36:06.400 that we're hopefully going to be publishing fairly 00:36:06.400 --> 00:36:10.639 shortly. So, yeah. And now, of course, I mean, 00:36:10.679 --> 00:36:13.539 you know, the past 10 years in particular, meetings 00:36:13.539 --> 00:36:16.739 are designed where both circadian and sleep are 00:36:16.739 --> 00:36:21.179 considered in the same meeting and the researchers 00:36:21.179 --> 00:36:23.579 mix. And I think that's been incredibly healthy 00:36:23.579 --> 00:36:26.900 for the field. Well, you talked about schizophrenia, 00:36:27.199 --> 00:36:29.599 so I'd love to unpack that first. The mental 00:36:29.599 --> 00:36:32.500 health element of sleep deprivation. So when 00:36:32.500 --> 00:36:35.340 we're talking about the horrendous mental ill 00:36:35.340 --> 00:36:37.800 health, addiction, suicide epidemic that we have, 00:36:37.900 --> 00:36:41.119 I think globally, but especially in the professions 00:36:41.119 --> 00:36:44.539 listening, again, as I mentioned before, the 00:36:44.539 --> 00:36:46.519 focus a lot of times is the trauma that we've 00:36:46.519 --> 00:36:49.460 seen. Now, there's undoubtedly a correlation 00:36:49.460 --> 00:36:52.059 between childhood trauma that... you know we 00:36:52.059 --> 00:36:54.039 had before we ever put a uniform on which is 00:36:54.039 --> 00:36:57.460 very very rarely discussed but in my profession 00:36:57.460 --> 00:37:00.380 in in the fire service in america the average 00:37:00.380 --> 00:37:03.380 work week is about 56 hours the 24 hour shifts 00:37:03.380 --> 00:37:05.199 which i'm not opposed to because we are in a 00:37:05.199 --> 00:37:07.639 building with beds and you know i think that's 00:37:07.639 --> 00:37:09.820 that's better than splitting it up into 12s and 00:37:09.820 --> 00:37:13.960 rotating it but they only they get 24 hours on 00:37:13.960 --> 00:37:17.860 and 48 hours off um so really that's a day between 00:37:17.860 --> 00:37:22.329 24 hours without sleep um so With that initial 00:37:22.329 --> 00:37:25.170 kind of thought process with the schizophrenia, 00:37:25.269 --> 00:37:27.949 was it a kind of chicken and egg scenario where 00:37:27.949 --> 00:37:30.750 the schizophrenia is making the sleep deprivation 00:37:30.750 --> 00:37:33.489 worse and or the sleep deprivation is initiating 00:37:33.489 --> 00:37:37.250 the schizophrenia? Yes and no. Really, what those 00:37:37.250 --> 00:37:41.110 observations in schizophrenia made me think, 00:37:41.130 --> 00:37:43.989 and of course our increasing understanding of 00:37:43.989 --> 00:37:46.269 the mechanisms underpinning the neurobiology 00:37:46.269 --> 00:37:48.789 of sleep, we produced a very straightforward 00:37:48.789 --> 00:37:52.940 conceptual model. which is that because the sleep 00:37:52.940 --> 00:37:56.019 -wake systems draw from all the brain neurotransmitter 00:37:56.019 --> 00:37:59.099 systems and an interaction between multiple brain 00:37:59.099 --> 00:38:01.619 structures, the hindbrain, the midbrain, the 00:38:01.619 --> 00:38:05.500 hypothalamus, the cortex, there's immense complexity. 00:38:06.019 --> 00:38:10.800 And we thought, well, hang on. Surely the pathways 00:38:10.800 --> 00:38:13.719 and the networks that give rise to normal mental 00:38:13.719 --> 00:38:17.199 health and the normal sleep -wake cycle overlap. 00:38:18.619 --> 00:38:22.019 So if you have a mental health condition, let's 00:38:22.019 --> 00:38:24.780 say an abnormality in a particular neurotransmitter 00:38:24.780 --> 00:38:27.320 that predisposes you to a mental health condition, 00:38:27.460 --> 00:38:30.579 it's going to have a parallel impact at some 00:38:30.579 --> 00:38:33.320 level on the sleep -wake timing systems and the 00:38:33.320 --> 00:38:35.300 sleep -wake systems in generally. The systems 00:38:35.300 --> 00:38:38.969 overlap. We've got evidence for that because 00:38:38.969 --> 00:38:40.969 genes that have been linked originally to mental 00:38:40.969 --> 00:38:44.409 health problems have now been shown to be very 00:38:44.409 --> 00:38:46.769 important in the regulation and the generation 00:38:46.769 --> 00:38:49.630 of the sleep -wake cycle and vice versa. So we've 00:38:49.630 --> 00:38:52.230 got empirical evidence for that. So there is, 00:38:52.309 --> 00:38:56.510 and we kind of know this, a genetic predisposition 00:38:56.510 --> 00:39:01.329 to have a mental health problem. And in parallel 00:39:01.329 --> 00:39:04.349 with that, it will generate a sleep problem at 00:39:04.349 --> 00:39:08.510 some level. Going to your point about the feedback 00:39:08.510 --> 00:39:11.889 loops, of course, because of the destabilizing 00:39:11.889 --> 00:39:14.369 effect of sleep and circadian rhythm disruption 00:39:14.369 --> 00:39:18.349 on physiological and behavioral and indeed mental 00:39:18.349 --> 00:39:22.750 health, that's going to exacerbate the mental 00:39:22.750 --> 00:39:25.710 health status and the mental health status, of 00:39:25.710 --> 00:39:28.829 course, and perhaps the drugs associated with 00:39:28.829 --> 00:39:31.800 mental health to treat it. are going to feedback 00:39:31.800 --> 00:39:35.039 and impact upon the sleep -wake disruption. So 00:39:35.039 --> 00:39:38.159 you can go from something at the core, which 00:39:38.159 --> 00:39:40.639 is a genetic predisposition of vulnerability, 00:39:41.119 --> 00:39:46.320 and move very rapidly to a critical state because 00:39:46.320 --> 00:39:50.139 you get that feedback loop where the sleep exaggerates 00:39:50.139 --> 00:39:52.000 the mental health and the mental health exaggerates 00:39:52.000 --> 00:39:55.760 the sleep. So if you follow that logic, you can 00:39:55.760 --> 00:39:58.869 say, OK, well, perhaps we can think about the 00:39:58.869 --> 00:40:01.170 sleep -wake system as being a therapeutic target. 00:40:01.769 --> 00:40:05.449 And so what we did, and Dan Freeman, a great 00:40:05.449 --> 00:40:08.650 colleague in psychiatry, led this study, we basically 00:40:08.650 --> 00:40:11.829 were able to use approaches which would stabilise 00:40:12.320 --> 00:40:17.739 sleep wake in individuals who had insomnia, but 00:40:17.739 --> 00:40:22.199 also had paranoia and hallucinatory experiences. 00:40:22.500 --> 00:40:26.099 And it was so phenomenal because just by stabilizing, 00:40:26.119 --> 00:40:28.739 partially stabilizing sleep wake, you actually 00:40:28.739 --> 00:40:32.599 reduced the severity, halved the levels of paranoia 00:40:32.599 --> 00:40:35.909 and hallucinatory experiences, showing really 00:40:35.909 --> 00:40:38.469 for the first time, that we can think about sleep 00:40:38.469 --> 00:40:42.449 as a therapeutic target for mental health conditions. 00:40:42.690 --> 00:40:46.389 So that's how that casual conversation in the 00:40:46.389 --> 00:40:49.690 elevator with a psychiatrist has gone. And now, 00:40:49.750 --> 00:40:53.710 of course, as you rightly point out, James, sleep 00:40:53.710 --> 00:40:55.969 -wake is regarded as an incredibly important 00:40:55.969 --> 00:41:02.320 element in both the... regulation, but also the 00:41:02.320 --> 00:41:04.800 prevention of mental health states. We now know, 00:41:04.820 --> 00:41:07.579 for example, that a change in the pattern of 00:41:07.579 --> 00:41:13.099 sleep is characteristic of either a first depressive 00:41:13.099 --> 00:41:16.480 episode or a recurrent depression. We've also 00:41:16.480 --> 00:41:20.420 shown that in kids who are vulnerable at high 00:41:20.420 --> 00:41:25.880 risk of developing bipolar are already showing 00:41:25.880 --> 00:41:29.809 a disturbed pattern of sleep -wake. prior to 00:41:29.809 --> 00:41:33.090 any clinical diagnosis of bipolar. And so what 00:41:33.090 --> 00:41:35.170 that opens up, of course, is you look at those 00:41:35.170 --> 00:41:37.829 kids who are vulnerable. If you stabilize sleep 00:41:37.829 --> 00:41:40.570 -wake in those individuals, then will you divert 00:41:40.570 --> 00:41:43.570 the brain into a different developmental pattern, 00:41:43.809 --> 00:41:47.429 avoiding, let's say, some of the problems of 00:41:47.429 --> 00:41:50.510 bipolar, or will you delay the onset of some 00:41:50.510 --> 00:41:52.269 of these conditions? Now, we don't know the answer 00:41:52.269 --> 00:41:54.849 to that, but what's now been appreciated is that 00:41:54.849 --> 00:41:57.750 intimate association between mental health and 00:41:57.750 --> 00:42:01.690 sleep. Well, my observations with multiple departments 00:42:01.690 --> 00:42:04.010 I've worked for in the East and the West Coast, 00:42:04.050 --> 00:42:08.010 I got to see different agencies, different shift 00:42:08.010 --> 00:42:09.909 patterns, but roughly the same work week if you 00:42:09.909 --> 00:42:13.679 break it down. seen with my own eyes more so 00:42:13.679 --> 00:42:15.539 once i left the fire service because when you're 00:42:15.539 --> 00:42:17.739 in it you your observational skills are not so 00:42:17.739 --> 00:42:19.920 good because you're so damn tired yourself but 00:42:19.920 --> 00:42:23.480 i've watched young firefighters deteriorate rapidly 00:42:23.480 --> 00:42:26.340 like where i where i coach and train now there's 00:42:26.340 --> 00:42:29.239 a few firefighters that began when i was there 00:42:29.239 --> 00:42:31.400 and now we're you know five plus years into their 00:42:31.400 --> 00:42:35.219 career so talk to me about the impact of sleep 00:42:35.219 --> 00:42:38.260 deprivation on on the brain what is it supposed 00:42:38.260 --> 00:42:40.280 to be doing at night and what is not happening 00:42:40.280 --> 00:42:43.460 with our doctors nurses police fire etc yeah 00:42:43.460 --> 00:42:46.380 i guess we can we can unpack this at two levels 00:42:46.380 --> 00:42:47.880 i mean first of all what do we know about what 00:42:47.880 --> 00:42:50.199 goes on in the brain whilst we sleep and we know 00:42:50.199 --> 00:42:53.760 that memory consolidation is critically important 00:42:53.760 --> 00:42:57.340 we know that it's not just the not just the laying 00:42:57.340 --> 00:43:00.940 down of facts in our brain, but also we're playing 00:43:00.940 --> 00:43:03.300 with information. So if you want to come up with 00:43:03.300 --> 00:43:05.760 innovative solutions to complex problems, a night 00:43:05.760 --> 00:43:08.679 of sleep has been shown overwhelmingly to be 00:43:08.679 --> 00:43:13.360 able to help you make important decisions and 00:43:13.360 --> 00:43:17.619 solve problems. So higher brain function is going 00:43:17.619 --> 00:43:19.519 on whilst we sleep. In fact, some areas of the 00:43:19.519 --> 00:43:22.039 brain are more active when we're asleep than 00:43:22.039 --> 00:43:25.130 when we're awake. We also know some important 00:43:25.130 --> 00:43:29.730 stuff that, for example, clearance of toxins 00:43:29.730 --> 00:43:33.710 such as misfolded proteins, such as beta amyloid, 00:43:33.789 --> 00:43:36.150 which, of course, has been associated with Alzheimer's 00:43:36.150 --> 00:43:38.630 disease. That's being packaged up and got rid 00:43:38.630 --> 00:43:41.889 of whilst we're asleep. And in fact, if you deprive 00:43:41.889 --> 00:43:45.010 people of sleep and then look for beta amyloid 00:43:45.010 --> 00:43:47.510 deposition within the brain, you can detect it 00:43:47.510 --> 00:43:51.829 after just one night of no sleep, which may be 00:43:51.829 --> 00:43:55.760 the mechanism. which accounts for the fact that 00:43:55.760 --> 00:43:58.820 if you have poor sleep in your middle years, 00:43:59.000 --> 00:44:03.239 it is a risk factor for dementia and Alzheimer's 00:44:03.239 --> 00:44:05.739 when you're older. Now, I would never say that 00:44:05.739 --> 00:44:08.099 poor sleep is going to cause Alzheimer's, but 00:44:08.099 --> 00:44:10.920 if you're vulnerable, then this could be an additional 00:44:10.920 --> 00:44:14.679 risk factor. So that's the sort of thing that 00:44:14.679 --> 00:44:17.039 we see. as being critically important whilst 00:44:17.039 --> 00:44:19.480 we sleep. But if you look at it in slightly different 00:44:19.480 --> 00:44:21.940 ways, what happens to you when you don't get 00:44:21.940 --> 00:44:24.440 sleep, and you suffer sleep and circadian rhythm 00:44:24.440 --> 00:44:26.820 disruption, and emotional and cognitive responses, 00:44:27.199 --> 00:44:30.619 you name it, it gets screwed up. So fluctuations 00:44:30.619 --> 00:44:34.079 in mood, negative salience, what that means is 00:44:34.079 --> 00:44:38.179 that the tired brain remembers negative experiences, 00:44:38.280 --> 00:44:41.960 but forgets positive ones. So one's whole decision 00:44:41.960 --> 00:44:46.010 making capability is based upon the negative 00:44:46.010 --> 00:44:48.550 stuff that you experience, not the positive stuff. 00:44:48.690 --> 00:44:50.469 I think that's such an important observation. 00:44:51.449 --> 00:44:56.190 Irritability, anxiety, loss of empathy and frustration, 00:44:56.969 --> 00:45:00.389 risk -taking and impulsivity. I think this is 00:45:00.389 --> 00:45:03.170 really interesting. You do stupid and unreflective 00:45:03.170 --> 00:45:05.170 things. So you're going, you think, oh yeah, 00:45:05.230 --> 00:45:08.530 I can make that, I can get through that stoplight 00:45:08.530 --> 00:45:12.000 before it turns red. And of course, Under normal 00:45:12.000 --> 00:45:14.019 circumstances, you wouldn't dream of it, but 00:45:14.019 --> 00:45:17.840 you kind of do stupid things when you're tired. 00:45:18.300 --> 00:45:21.019 There's a greater use of stimulants to try and 00:45:21.019 --> 00:45:25.599 override this overwhelming sensation of sleepiness. 00:45:27.079 --> 00:45:29.400 Of course, decreased cognitive performance. You 00:45:29.400 --> 00:45:31.840 can't process information, poor memory, poor 00:45:31.840 --> 00:45:34.460 concentration, poor communication skills. You 00:45:34.460 --> 00:45:37.039 can't actually articulate what you want. You 00:45:37.039 --> 00:45:39.340 can't find the right words to actually express 00:45:39.340 --> 00:45:43.400 yourself appropriately. And reduced social connectivity. 00:45:43.639 --> 00:45:46.659 You don't feel as though you're part of, you 00:45:46.659 --> 00:45:51.139 know, your community and your family. And you 00:45:51.139 --> 00:45:54.320 feel that it's sort of somewhat detached. And 00:45:54.320 --> 00:45:56.960 bearing in mind, I mean, we can talk about this 00:45:56.960 --> 00:45:59.380 later, but, you know, the divorce rate, and I'm 00:45:59.380 --> 00:46:02.539 sure you've seen this, James. in certain areas 00:46:02.539 --> 00:46:05.239 of night shift work is so much higher than in 00:46:05.239 --> 00:46:06.639 day shift. In fact, there was a study from the 00:46:06.639 --> 00:46:09.559 state which showed that night shift workers doing 00:46:09.559 --> 00:46:11.800 the same job had a divorce rate which was six 00:46:11.800 --> 00:46:16.500 times higher than the day shift. And that can 00:46:16.500 --> 00:46:19.760 kick in under relatively short term. So switching 00:46:19.760 --> 00:46:22.500 between night shift and day shift, tiredness, 00:46:22.519 --> 00:46:24.380 circadian rhythm disruption, you're going to 00:46:24.380 --> 00:46:28.039 see this. And of course, that's why we need to 00:46:28.039 --> 00:46:30.789 know about it so that we can at least be sensitive 00:46:30.789 --> 00:46:33.409 to the fact that we may be going down that route. 00:46:34.489 --> 00:46:38.289 Longer term night shift work, sort of the chronic 00:46:38.289 --> 00:46:41.230 impact on physiology and health, well of course 00:46:41.230 --> 00:46:44.090 there's daytime sleepiness which you can get 00:46:44.090 --> 00:46:46.349 for short term but this becomes a really sort 00:46:46.349 --> 00:46:49.489 of chronic problem. Microsleeps, it's estimated 00:46:49.489 --> 00:46:54.510 that there are at least 200 ,000 crashes every 00:46:54.510 --> 00:46:59.650 year on the freeway as a result of microsleeps. 00:46:59.650 --> 00:47:02.130 This uncontrollable falling asleep at the wheel. 00:47:02.250 --> 00:47:04.789 I think the American Automobile Association says 00:47:04.789 --> 00:47:07.449 it could be actually three times greater than 00:47:07.449 --> 00:47:10.309 that. So it's 300 ,000. Difficult to know. These 00:47:10.309 --> 00:47:12.730 are particularly bad, of course, because unlike 00:47:12.730 --> 00:47:16.070 other crashes where you are at least awake to 00:47:16.070 --> 00:47:18.730 stop yourself. crashing into the car in front 00:47:18.730 --> 00:47:20.530 of you or the barrier, you've fallen asleep. 00:47:20.670 --> 00:47:22.989 So there's no recovery. So they tend to be faster 00:47:22.989 --> 00:47:29.269 and more damaging. Cardiovascular disease, altered 00:47:29.269 --> 00:47:32.289 stress responses. You know, you've got the activating 00:47:32.289 --> 00:47:35.750 sort of cortisol and adrenaline. And of course, 00:47:35.750 --> 00:47:38.150 that's feeding back. It's lowering immunity. 00:47:38.960 --> 00:47:42.619 making you more vulnerable to infection. And 00:47:42.619 --> 00:47:44.699 it's probably increasing vulnerability to cancer. 00:47:44.800 --> 00:47:47.920 Classic studies on night shift nurses, higher 00:47:47.920 --> 00:47:51.059 rates of colorectal cancer, breast cancer, and 00:47:51.059 --> 00:47:55.159 in airline pilots, long -haul airline pilots, 00:47:55.239 --> 00:47:57.579 higher rates of prostate cancer, for example. 00:47:58.420 --> 00:48:01.699 Big metabolic abnormalities, you know, such as 00:48:01.699 --> 00:48:05.789 obesity, type 2 diabetes. And of course, as we've 00:48:05.789 --> 00:48:08.130 already touched on, greater vulnerability to 00:48:08.130 --> 00:48:11.329 depression and psychosis. So I think it's so 00:48:11.329 --> 00:48:16.239 important to appreciate that. sort of shift work, 00:48:16.420 --> 00:48:20.280 sleep and circadian rhythm disruption is so much 00:48:20.280 --> 00:48:23.059 more than the irritation of feeling tired at 00:48:23.059 --> 00:48:26.000 an inappropriate time. It has an impact upon 00:48:26.000 --> 00:48:29.400 our entire global health, our ability to process 00:48:29.400 --> 00:48:32.659 information, respond to other people, our whole 00:48:32.659 --> 00:48:37.000 mood, but it also longer term impacts upon our 00:48:37.000 --> 00:48:41.840 physiological health as well. It's a really serious 00:48:41.840 --> 00:48:44.679 issue. I mean, World Health Organization now, 00:48:44.860 --> 00:48:48.260 because of the links between cancer and night 00:48:48.260 --> 00:48:51.199 shift work, have identified night shift work 00:48:51.199 --> 00:48:55.280 as a probable carcinogen. You know, this is serious 00:48:55.280 --> 00:49:00.639 stuff. But I think, so why aren't people more 00:49:00.639 --> 00:49:04.519 sort of tuned into this? Why is it kind of dismissed? 00:49:04.699 --> 00:49:07.920 And I think it's getting better. But those of 00:49:07.920 --> 00:49:11.420 us who remember the 80s, you know, when it was 00:49:11.420 --> 00:49:14.260 in its lowest point, I guess, where people will 00:49:14.260 --> 00:49:16.019 come into work and say, yeah, I've done another 00:49:16.019 --> 00:49:18.420 all nighter. You know, people pat him on the 00:49:18.420 --> 00:49:21.739 back and say, oh, how cool. And I think we are 00:49:21.739 --> 00:49:24.940 beginning to realize that those sorts of people 00:49:24.940 --> 00:49:27.000 will be despised in the same way that we now 00:49:27.000 --> 00:49:30.460 despise smokers as not only causing harm to themselves, 00:49:30.800 --> 00:49:33.440 but potential harm to others. You know, secondary 00:49:33.440 --> 00:49:36.380 smoke of secondary accidents. I mean, you know. 00:49:36.670 --> 00:49:39.969 tired pilots. And there's some really interesting 00:49:39.969 --> 00:49:44.190 studies. There was an India crash over a decade 00:49:44.190 --> 00:49:49.550 ago where the plane was landing and the plane 00:49:49.550 --> 00:49:54.829 hit the deck and most of the passengers and crew 00:49:54.829 --> 00:49:59.130 were killed. And what happened is that the pilot 00:49:59.130 --> 00:50:01.670 had simply had a microsleep, had fallen asleep. 00:50:02.360 --> 00:50:04.900 in the middle of landing the plane, this overwhelming 00:50:04.900 --> 00:50:08.639 sense of tiredness. And how do we know that? 00:50:08.880 --> 00:50:10.980 Because he was killed. Well, we know that because 00:50:10.980 --> 00:50:13.920 you could hear him snoring on the voice recorder 00:50:13.920 --> 00:50:16.840 in the cockpit. So, you know, it's not only harm 00:50:16.840 --> 00:50:20.579 to yourself, but those passengers were killed 00:50:20.579 --> 00:50:25.579 as a result of that individual suffering sleep 00:50:25.579 --> 00:50:28.900 and circadian rhythm disruption. So, yeah, I 00:50:28.900 --> 00:50:31.420 can't emphasize how important it is. Well, I 00:50:31.420 --> 00:50:33.639 mean, you've literally summed up everything that 00:50:33.639 --> 00:50:36.260 this community itself is from. And I think that's 00:50:36.260 --> 00:50:38.460 the problem is, you know, if we just look at 00:50:38.460 --> 00:50:40.599 carcinogens in our gear, we miss the cancer, 00:50:40.699 --> 00:50:42.440 you know, big piece of the cancer puzzle. If 00:50:42.440 --> 00:50:44.119 we just look at trauma, we miss a big piece of 00:50:44.119 --> 00:50:48.960 the mental health puzzle. When I hear, I think 00:50:48.960 --> 00:50:51.300 Dr. John Cordell, I think it was, who's a retired 00:50:51.300 --> 00:50:55.079 naval captain, I think I've got that right. He 00:50:55.079 --> 00:50:57.960 cited the Exxon Valdez and I think it was Fukushima 00:50:57.960 --> 00:51:00.219 and some of these massive, massive incidents 00:51:00.219 --> 00:51:04.000 that we had were all related somewhat to sleep 00:51:04.000 --> 00:51:06.440 deprivation. And you think about all the millions 00:51:06.440 --> 00:51:08.860 of men and women that are behind an emergency 00:51:08.860 --> 00:51:11.940 vehicle day in, day out. And I think of some 00:51:11.940 --> 00:51:13.559 of the, what we call line of duty deaths, some 00:51:13.559 --> 00:51:15.400 of the people that are killed whilst wearing 00:51:15.400 --> 00:51:18.480 the uniform. They fall off the aerial, the giant 00:51:18.480 --> 00:51:20.219 ladder that we have. They get lost in a burning 00:51:20.219 --> 00:51:23.099 building. They crash an intersection and kill 00:51:23.099 --> 00:51:25.920 a bunch of civilians as well. How many of those 00:51:25.920 --> 00:51:27.960 were actually related to sleep deprivation? And 00:51:27.960 --> 00:51:30.519 then the chronic impact. There's a kind of, I 00:51:30.519 --> 00:51:34.260 guess, unsubstantiated but pretty well -accepted 00:51:34.260 --> 00:51:36.539 figure that a lot of us die within five years 00:51:36.539 --> 00:51:39.300 of retirement. And the sad thing in America is 00:51:39.300 --> 00:51:42.800 the fire service. The day we leave the fire station 00:51:42.800 --> 00:51:45.039 for the last time, we cease to be a statistic. 00:51:45.760 --> 00:51:48.260 So all these retirees that are dropping dead 00:51:48.260 --> 00:51:50.480 like flies, and I just lost one from Anaheim, 00:51:50.480 --> 00:51:54.059 a young fire captain died last week, 56 years 00:51:54.059 --> 00:51:56.679 old. They're not factoring into the science. 00:51:56.739 --> 00:51:59.260 So again, there's this kind of turning a blind 00:51:59.260 --> 00:52:02.780 eye to not only the acute impact of sleep deprivation, 00:52:02.840 --> 00:52:05.420 but also the chronic impact. Well, I think it's 00:52:05.420 --> 00:52:08.880 a good example where long -term follow -up. is 00:52:08.880 --> 00:52:12.179 absolutely essential in this sector. And the 00:52:12.179 --> 00:52:14.219 health and wellbeing of these individuals needs 00:52:14.219 --> 00:52:21.260 to be tracked beyond retirement. And one thing 00:52:21.260 --> 00:52:26.639 I think we need to clarify, though, is that frontline 00:52:26.639 --> 00:52:30.599 staff, whether it's police, fire services, our 00:52:30.599 --> 00:52:33.800 medical professions, they're needed on a 24 -7 00:52:33.800 --> 00:52:39.210 basis. And in fact, society generally now runs 00:52:39.210 --> 00:52:41.909 on a 24 -7 basis. And so we're not going to put 00:52:41.909 --> 00:52:45.369 that genie back in its bottle. So the key thing 00:52:45.369 --> 00:52:49.269 for me is you can't say you shouldn't do it. 00:52:49.369 --> 00:52:52.190 What we've got to do is look for ways in which 00:52:52.190 --> 00:52:56.250 these issues are mitigated. And so we know that 00:52:56.250 --> 00:52:59.570 long -term night shift work is where things can 00:52:59.570 --> 00:53:03.090 really build up. And so perhaps we should limit 00:53:03.090 --> 00:53:07.579 night shift work. to five years and then rotate 00:53:07.579 --> 00:53:10.599 people back on to only day shift. That's one 00:53:10.599 --> 00:53:12.880 sort of thought. But if we think about the various 00:53:12.880 --> 00:53:15.539 problems, so after extended periods of work, 00:53:15.679 --> 00:53:19.119 there's a greater risk of having an accident 00:53:19.119 --> 00:53:22.139 on the drive home. So there was a study on junior 00:53:22.139 --> 00:53:26.219 doctors in the UK showing that 57 % had either 00:53:26.219 --> 00:53:29.139 had a crash or a near miss on the drive home 00:53:29.139 --> 00:53:32.039 after the night shift. So what should we provide 00:53:32.039 --> 00:53:35.809 for those individuals? Well, in Western Australia, 00:53:35.929 --> 00:53:37.909 for example, the junior doctors are sent home 00:53:37.909 --> 00:53:41.670 in a taxi. But what we could do really easily 00:53:41.670 --> 00:53:45.349 and at low cost is use an app on a smartphone 00:53:45.349 --> 00:53:49.489 which detects head nod or movement of the car 00:53:49.489 --> 00:53:51.789 and alerts somebody to the fact that they're 00:53:51.789 --> 00:53:54.849 falling asleep while they're driving home. And 00:53:54.849 --> 00:53:57.230 in fact, of course, high -end German cars now 00:53:57.230 --> 00:53:59.570 have that technology built into them. But we 00:53:59.570 --> 00:54:02.210 could provide that to, again, reduce the risk 00:54:02.210 --> 00:54:05.619 of falling asleep at the wheel. loss of vigilance 00:54:05.619 --> 00:54:09.699 and tiredness in the workplace, we can increase 00:54:09.699 --> 00:54:11.840 the amount of light, which increases levels of 00:54:11.840 --> 00:54:14.599 alertness. That's not probably particularly useful, 00:54:14.739 --> 00:54:19.300 I think, for fire services, but other 24 -7 factory 00:54:19.300 --> 00:54:22.340 workers, for example. I think a really, really 00:54:22.340 --> 00:54:24.940 important area is poor physical and mental health. 00:54:25.119 --> 00:54:28.019 We should be having higher frequency health checks 00:54:28.019 --> 00:54:32.710 in this sector to identify these vulnerabilities 00:54:32.710 --> 00:54:36.090 and problems before they become chronic and you 00:54:36.090 --> 00:54:38.769 can't do anything about them. And I think there's 00:54:38.769 --> 00:54:42.349 an immense duty of care here that people need 00:54:42.349 --> 00:54:44.590 to recognize this increased vulnerability and 00:54:44.590 --> 00:54:47.250 do something about it, check for it, screen for 00:54:47.250 --> 00:54:50.670 it. We know if you catch cancer early, there's 00:54:50.670 --> 00:54:55.190 hugely success rates in long -term survival. 00:54:55.369 --> 00:54:58.670 But if you detect it late on, You know, there's 00:54:58.670 --> 00:55:01.469 not an awful lot. And if it started to spread, 00:55:01.630 --> 00:55:04.710 it's really bad. So high frequency health checks. 00:55:05.250 --> 00:55:07.769 So knowing that night shift workers have high 00:55:07.769 --> 00:55:11.210 levels of obesity, diabetes 2, metabolic abnormalities, 00:55:11.389 --> 00:55:13.869 what kind of food do we make available to our 00:55:13.869 --> 00:55:16.829 night shift workers? It's high fat. It's high 00:55:16.829 --> 00:55:19.269 sugar. And of course, we're predisposed when 00:55:19.269 --> 00:55:21.630 we're tired to want that kind of stuff. But there's 00:55:21.630 --> 00:55:24.769 no alternative. So what you want is high protein. 00:55:25.340 --> 00:55:28.719 easy to digest snacks throughout the night shift, 00:55:28.840 --> 00:55:32.099 which are not going to send your metabolism and 00:55:32.099 --> 00:55:34.820 waistline into meltdown. And to my knowledge, 00:55:34.860 --> 00:55:37.179 I don't think anybody's doing that in the sector, 00:55:37.280 --> 00:55:40.019 which is completely bizarre. It's low hanging 00:55:40.019 --> 00:55:44.539 fruit. It's something we could easily do. The 00:55:44.539 --> 00:55:48.239 failure to consequence, to appreciate the consequences 00:55:48.239 --> 00:55:51.639 of shortened and disrupted sleep. And I think, 00:55:51.659 --> 00:55:53.780 again, it's developing the educational materials 00:55:53.780 --> 00:55:57.579 so people know that there's a danger and know 00:55:57.579 --> 00:56:00.260 what they're getting into and to know what kind 00:56:00.260 --> 00:56:03.219 of problems they might experience. And it's not 00:56:03.219 --> 00:56:06.920 just for the individual. It's for the extended 00:56:06.920 --> 00:56:12.300 family unit. So partners appreciate that. It's 00:56:12.300 --> 00:56:14.300 not that this loved one has turned into a monster. 00:56:14.559 --> 00:56:17.969 It's the fact that this is. basically an inevitable 00:56:17.969 --> 00:56:21.110 consequence of driving your biology outside of 00:56:21.110 --> 00:56:23.869 its normal range by doing night shift work. And 00:56:23.869 --> 00:56:27.650 I think if people knew this, they'd be much more 00:56:27.650 --> 00:56:31.389 understanding of some of the odd behaviours that 00:56:31.389 --> 00:56:34.690 night shift workers display. So education, I 00:56:34.690 --> 00:56:37.389 think, is so important, not only to the individual, 00:56:37.449 --> 00:56:39.889 but to the extended family group and partners. 00:56:42.170 --> 00:56:45.010 So anxiety over apps, for example, sleep apps, 00:56:45.150 --> 00:56:48.469 most of them are completely useless. They're 00:56:48.469 --> 00:56:50.030 good for telling you roughly when you went to 00:56:50.030 --> 00:56:51.730 sleep and when you woke up and how many times 00:56:51.730 --> 00:56:53.530 you woke up in the night. But when they start 00:56:53.530 --> 00:56:55.710 telling you about, oh, you had really good restorative 00:56:55.710 --> 00:56:57.809 sleep or, oh, you had a bad night's sleep, they 00:56:57.809 --> 00:57:01.670 can't do this. They're not. They just can't work 00:57:01.670 --> 00:57:04.210 effectively. None of them are endorsed by the 00:57:04.210 --> 00:57:06.949 sleep federations. None of them are FDA approved. 00:57:07.329 --> 00:57:10.090 And so don't take these things seriously. They 00:57:10.090 --> 00:57:13.650 can actually generate increased anxiety. And 00:57:13.650 --> 00:57:17.349 one other area is that we know there's a biological 00:57:17.349 --> 00:57:20.469 underpinning of being a morning person and an 00:57:20.469 --> 00:57:23.050 evening person and an intermediate person. And 00:57:23.050 --> 00:57:25.860 that's called chronotype. And I don't understand 00:57:25.860 --> 00:57:28.599 why we don't chronotype our workforce to make 00:57:28.599 --> 00:57:31.679 sure that the late types are best suited for 00:57:31.679 --> 00:57:34.559 the late shifts. The morning types are best suited 00:57:34.559 --> 00:57:36.340 for the morning shifts. And what you want to 00:57:36.340 --> 00:57:39.739 avoid at all costs is a late person, a late chronotype, 00:57:39.940 --> 00:57:42.960 working on the early shift. Because then there's 00:57:42.960 --> 00:57:45.760 the greatest sort of what's called social jet 00:57:45.760 --> 00:57:48.340 lag, the difference between your biological preferred 00:57:48.340 --> 00:57:50.860 sleep -wake patterns and what's being imposed 00:57:50.860 --> 00:57:54.559 upon you as a result of job or societal needs. 00:57:54.840 --> 00:57:59.679 So I think it's not all hand -wringing. We're 00:57:59.679 --> 00:58:01.539 not going to completely get rid of the problems. 00:58:02.170 --> 00:58:05.210 But I do think there are low hanging fruit that 00:58:05.210 --> 00:58:08.449 we could adopt now on the basis of the knowledge 00:58:08.449 --> 00:58:11.769 we have now to just mitigate some of these problems. 00:58:12.449 --> 00:58:16.150 So we're not stacking it up for even worse long 00:58:16.150 --> 00:58:20.309 term problems. Yeah, and I agree with everything 00:58:20.309 --> 00:58:23.320 that you said. And it's sad because. The conversation, 00:58:23.340 --> 00:58:26.360 for example, with the fitness is a lot of times 00:58:26.360 --> 00:58:28.199 put on the responder's shoulders where you need 00:58:28.199 --> 00:58:30.079 to work out more. And I agree, you do. There's 00:58:30.079 --> 00:58:31.960 an element of ownership in what we do, what we 00:58:31.960 --> 00:58:35.980 sign up for. But that's kind of hypocrisy if 00:58:35.980 --> 00:58:38.639 you're not creating an environment that allows 00:58:38.639 --> 00:58:40.619 them mentally and physically to have the motivation 00:58:40.619 --> 00:58:47.019 and focus and energy levels to walk into a gym 00:58:47.019 --> 00:58:50.510 and take your health seriously. Yeah. And I think 00:58:50.510 --> 00:58:53.309 the problem is that the employers kind of know 00:58:53.309 --> 00:58:58.550 about this. But most of them, the business sector 00:58:58.550 --> 00:59:01.110 is becoming much more sensitive to it, incidentally. 00:59:01.110 --> 00:59:03.070 But most of them are just sort of sticking their 00:59:03.070 --> 00:59:06.090 head in the sand. And my real concern is that 00:59:06.090 --> 00:59:07.889 there's going to be a series of class action 00:59:07.889 --> 00:59:11.210 suits where the whole thing becomes litigious 00:59:11.210 --> 00:59:14.309 and reasonable dialogue between employers and 00:59:14.309 --> 00:59:18.530 employees to try and get a better solution is 00:59:18.530 --> 00:59:21.750 going to be. cast into the out of darkness. I 00:59:21.750 --> 00:59:24.849 mean, you know, an employer could easily go and 00:59:24.849 --> 00:59:27.190 say, well, hang on, you know, we know this stuff. 00:59:27.309 --> 00:59:29.809 There are books published on this stuff. Why 00:59:29.809 --> 00:59:32.530 have you chosen to ignore it? And so I think 00:59:32.530 --> 00:59:35.489 we've got to move quickly before it turns ugly 00:59:35.489 --> 00:59:38.409 and that we then are not being in a position 00:59:38.409 --> 00:59:41.820 where we can do something constructive now. So 00:59:41.820 --> 00:59:44.199 one of the problems I face, one of the doors 00:59:44.199 --> 00:59:48.659 that I'm breaking my foot on constantly is in 00:59:48.659 --> 00:59:52.840 America specifically, the bare minimum work week 00:59:52.840 --> 00:59:55.739 is 48, 56 hours. So basically, like I said, 24 00:59:55.739 --> 00:59:58.559 hours straight, no sleep. And I mean, genuinely, 00:59:58.579 --> 01:00:00.699 a lot of these departments are either awake or 01:00:00.699 --> 01:00:02.719 are getting terrible quality sleep because you're 01:00:02.719 --> 01:00:05.860 waiting to be woken up. And then 24 hours off. 01:00:05.940 --> 01:00:08.260 So basically, that first day you go home, you've 01:00:08.260 --> 01:00:11.480 already worked eight of that. that 24 then you 01:00:11.480 --> 01:00:14.019 go home and then the next day you're actually 01:00:14.019 --> 01:00:18.440 ramping up to go back again so my there's there's 01:00:18.440 --> 01:00:20.800 departments up in the northeast and there's a 01:00:20.800 --> 01:00:24.980 couple around the u .s that do 24 72 so there's 01:00:24.980 --> 01:00:28.980 another 24 hour period between shifts from speaking 01:00:28.980 --> 01:00:31.159 to people that have done both you know they they 01:00:31.159 --> 01:00:33.659 report you know it's a much better system to 01:00:33.659 --> 01:00:36.760 me i love the phrase don't wait for Don't wait 01:00:36.760 --> 01:00:38.340 for science to prove what you already know. So 01:00:38.340 --> 01:00:40.960 people will come to me and say, oh, but can you 01:00:40.960 --> 01:00:43.719 show me studies on how this 56 -hour week is 01:00:43.719 --> 01:00:45.980 worse than this 42 -hour week? And I'm like, 01:00:46.079 --> 01:00:48.960 really? Did you just ask me that? Firstly, the 01:00:48.960 --> 01:00:50.960 sleep medicine world has all kinds of books, 01:00:51.000 --> 01:00:53.659 including yours. But secondly, look, I mean, 01:00:53.679 --> 01:00:55.420 you have Alison Brager and Rachel Mockwald and 01:00:55.420 --> 01:00:57.219 all these military people that have come on talking 01:00:57.219 --> 01:01:01.420 about the same thing. So with that being said. 01:01:02.259 --> 01:01:04.780 If in this particular system, and we're talking 01:01:04.780 --> 01:01:06.360 about bare minimum, a lot of these men and women 01:01:06.360 --> 01:01:09.300 are then told at 7 a .m., you can't go home. 01:01:09.420 --> 01:01:12.000 We need you to stay another 24 because we're 01:01:12.000 --> 01:01:14.139 short staffed. So now you're getting into 80 01:01:14.139 --> 01:01:17.119 plus hour weeks. My California department, just 01:01:17.119 --> 01:01:21.619 to prove from what I've been told, 168 hour work 01:01:21.619 --> 01:01:24.699 week if needed, which is, I mean, absolute insanity. 01:01:24.980 --> 01:01:28.360 And this is, of course, throughout the sector. 01:01:28.500 --> 01:01:31.280 I mean, you know, during COVID, frontline staff, 01:01:31.659 --> 01:01:37.239 in the hospitals were often expected to do that. 01:01:37.300 --> 01:01:40.039 And in fact, in the UK at the moment, we're chronically 01:01:40.039 --> 01:01:43.659 short of hospital staff because so many are off 01:01:43.659 --> 01:01:48.340 sick with either mental health problems or COVID 01:01:48.340 --> 01:01:51.639 or something else. And that just then throws 01:01:51.639 --> 01:01:56.119 greater pressure onto the people who are at work. 01:01:56.300 --> 01:02:01.699 And I think, you see, Frontline staff like yourself 01:02:01.699 --> 01:02:05.719 are good citizens. They do the job largely because 01:02:05.719 --> 01:02:07.320 they want to help. They want to make a difference. 01:02:07.539 --> 01:02:11.280 And so when asked to plug a gap, they always 01:02:11.280 --> 01:02:14.639 will. That's true for the police. It's true for 01:02:14.639 --> 01:02:17.500 nursing staff, for doctors across the sector. 01:02:20.780 --> 01:02:24.880 And the employers know that you're going to do 01:02:24.880 --> 01:02:28.659 that. And I think they need to say, look, this 01:02:28.659 --> 01:02:31.530 is not right. It needs to come from the employers, 01:02:31.809 --> 01:02:34.429 not the employees, because then you're guilt 01:02:34.429 --> 01:02:37.389 tripped if you say no. They need to recognise 01:02:37.389 --> 01:02:40.550 what they're inflicting on their staff and say, 01:02:40.650 --> 01:02:43.369 actually, this is not acceptable. We have to 01:02:43.369 --> 01:02:47.010 find an alternative. And whether it's, you know, 01:02:47.010 --> 01:02:49.989 having a pool of backup people that you call 01:02:49.989 --> 01:02:53.730 upon. But it is entirely unreasonable to expect 01:02:53.730 --> 01:02:56.789 somebody who's already chronically tired to then. 01:02:57.389 --> 01:03:01.309 carry on and endanger both their lives and other 01:03:01.309 --> 01:03:05.130 people. So again, I think it's a dialogue between 01:03:05.130 --> 01:03:08.349 employers and employees about finding these solutions 01:03:08.349 --> 01:03:10.929 without making it worse. And of course, currently, 01:03:11.130 --> 01:03:15.369 it's making the situation worse. And it relies 01:03:15.369 --> 01:03:19.449 on the goodwill of people like yourself, who 01:03:19.449 --> 01:03:22.469 will, of course, say, yeah, okay, this is really... 01:03:22.719 --> 01:03:25.300 crap but you know i've got to do it because i 01:03:25.300 --> 01:03:28.860 need it um and in and in fact there's got to 01:03:28.860 --> 01:03:33.340 be an alternative um and um again it's got to 01:03:33.340 --> 01:03:36.139 emerge from discussion uh from employers and 01:03:36.139 --> 01:03:39.179 employees well one thing that's come up and again 01:03:39.179 --> 01:03:42.900 there isn't the the research as far as actual 01:03:42.900 --> 01:03:45.280 numbers but again it's perfect common sense because 01:03:45.280 --> 01:03:48.340 as you touched on before sleep deprivation affects 01:03:48.340 --> 01:03:51.889 us in every way so at As you progress through 01:03:51.889 --> 01:03:55.050 a career, an employer has to spend a huge amount 01:03:55.050 --> 01:03:59.750 of money on everywhere from wrongful injury lawsuits 01:03:59.750 --> 01:04:02.989 to workman's comp claims, medical retirement, 01:04:03.190 --> 01:04:07.789 land of duty deaths. And so therefore, the money 01:04:07.789 --> 01:04:09.869 that's already being spent. it wouldn't take 01:04:09.869 --> 01:04:12.210 all of that to reinvest into higher staffing 01:04:12.210 --> 01:04:14.570 and therefore save that employer money as well. 01:04:14.750 --> 01:04:18.309 So in your opinion, if more time was put between 01:04:18.309 --> 01:04:20.550 these shifts, knowing that we have to have someone 01:04:20.550 --> 01:04:23.449 to protect our streets every night, if we gave 01:04:23.449 --> 01:04:25.730 them more rest and recovery between each shift, 01:04:25.809 --> 01:04:27.650 what impact would that have on physiological 01:04:27.650 --> 01:04:31.280 and mental health? It would improve both physiological 01:04:31.280 --> 01:04:33.960 and mental health, reduce the accidents, and 01:04:33.960 --> 01:04:36.699 therefore the collateral damage inflicting upon 01:04:36.699 --> 01:04:40.840 perfectly innocent bystanders. And so, yeah, 01:04:40.920 --> 01:04:44.340 I mean, one of the reasons I moved from Imperial 01:04:44.340 --> 01:04:50.179 to Oxford 16, 17 years ago was the opportunity 01:04:50.179 --> 01:04:53.139 of setting up this institute, the Sleep and Cicadian 01:04:53.139 --> 01:04:55.639 Neuroscience Institute. And we have four strategic 01:04:55.639 --> 01:04:58.739 aims. One is to understand the fundamental biology. 01:04:59.440 --> 01:05:02.699 of sleep generation, sleep circadian generation 01:05:02.699 --> 01:05:06.059 and its regulation. Two is to understand how 01:05:06.059 --> 01:05:09.619 these systems fail as a result of societal pressures, 01:05:09.780 --> 01:05:12.539 such as night shift work or disease, such as 01:05:12.539 --> 01:05:15.380 mental health, or indeed other sorts of diseases, 01:05:15.659 --> 01:05:18.840 neurodevelopmental diseases. The third is to 01:05:18.840 --> 01:05:22.000 develop evidence -based and condition specific 01:05:22.000 --> 01:05:26.780 interventions to try and mitigate some of these 01:05:26.780 --> 01:05:29.019 problems that we've been talking about. And then 01:05:29.019 --> 01:05:32.719 the fourth is to develop resources that educate 01:05:32.719 --> 01:05:35.079 the broader community about what's going on. 01:05:35.280 --> 01:05:38.219 And one of the great problems is that people 01:05:38.219 --> 01:05:40.760 don't know about this stuff. In a five -year 01:05:40.760 --> 01:05:44.760 medical training, most medics will have no lectures 01:05:44.760 --> 01:05:48.000 at all, or maybe one or two, on sleep, on circadian 01:05:48.000 --> 01:05:49.659 rhythms. And if they do have something on sleep, 01:05:49.760 --> 01:05:52.820 it'll be about electroencephalography and how 01:05:52.820 --> 01:05:55.519 it changes when you have schizophrenia or whatever. 01:05:56.239 --> 01:05:59.139 And so what we've set up is a whole bunch of 01:05:59.139 --> 01:06:01.900 educational tools, one of which is the first 01:06:01.900 --> 01:06:06.059 fully online master's degree and diploma in sleep 01:06:06.059 --> 01:06:09.110 medicine. So we've now got over 200 people all 01:06:09.110 --> 01:06:11.849 over the world, health care professionals taking 01:06:11.849 --> 01:06:15.469 this. And we organize tutorials at sort of the 01:06:15.469 --> 01:06:19.550 time zone, appropriate time. And there's an opportunity 01:06:19.550 --> 01:06:23.929 to come to Oxford and to take part in a summer 01:06:23.929 --> 01:06:26.389 school. And I think what we've got to do is get 01:06:26.389 --> 01:06:28.469 the information out there because there's this 01:06:28.469 --> 01:06:32.369 sort of. I mean, most of society doesn't appreciate 01:06:32.369 --> 01:06:36.210 the value of sleep. It's a luxury, an indulgence. 01:06:36.309 --> 01:06:39.110 And actually, it's such a fundamental part of 01:06:39.110 --> 01:06:41.849 our biology. We've just thrown it away without 01:06:41.849 --> 01:06:44.809 appreciating the consequences. And so the excitement 01:06:44.809 --> 01:06:48.269 for me in the last gasp of my career is to have 01:06:48.269 --> 01:06:51.150 established this institute and working with the 01:06:51.150 --> 01:06:54.230 next generation coming through on all of these 01:06:54.230 --> 01:06:56.530 areas, fundamental science. all the way through 01:06:56.530 --> 01:06:59.449 to its application, the development of new interventions, 01:07:00.190 --> 01:07:03.750 and critically the educational component whereby 01:07:03.750 --> 01:07:06.309 we can get this information across to the various 01:07:06.309 --> 01:07:10.769 sectors. And hopefully we can start to engage 01:07:10.769 --> 01:07:13.809 government in this regard. So there's, again, 01:07:13.809 --> 01:07:19.550 authoritative websites with the best science 01:07:19.550 --> 01:07:24.960 explained in the... in the simplest and most 01:07:24.960 --> 01:07:28.159 adjustable way. We're not there yet, but that's 01:07:28.159 --> 01:07:31.800 sort of the next door that I'm kicking at. I 01:07:31.800 --> 01:07:33.280 might have to look into that myself, actually. 01:07:33.320 --> 01:07:36.920 I got my bachelor's in exercise physiology, so 01:07:36.920 --> 01:07:39.340 I might have to even explore the long list of 01:07:39.340 --> 01:07:42.130 students. Yeah, that would be great. Brilliant. 01:07:42.130 --> 01:07:44.150 All right. Well, then another area, it's been 01:07:44.150 --> 01:07:46.090 interesting. I was first exposed really to the 01:07:46.090 --> 01:07:48.510 sleep medicine world by Dr. Kirk Parsley. I don't 01:07:48.510 --> 01:07:49.849 know if you've ever heard that name. He was a 01:07:49.849 --> 01:07:54.090 Navy SEAL. Yes. We've never met. And so, again, 01:07:54.630 --> 01:07:56.849 I'm sure what he was taught and believed back 01:07:56.849 --> 01:08:00.690 then has again had a genesis to now. So I'd love 01:08:00.690 --> 01:08:03.469 to kind of fact check a little bit. But one of 01:08:03.469 --> 01:08:05.750 the interesting things that he talked about was. 01:08:06.349 --> 01:08:08.570 tbi which again a lot of people listening military 01:08:08.570 --> 01:08:11.409 law enforcement myself i've been a combat athlete 01:08:11.409 --> 01:08:14.369 for quite a long time we have that tbi element 01:08:14.369 --> 01:08:17.390 which from what i understand one portion is demyelination 01:08:17.390 --> 01:08:20.409 of the the sheath and then you have from what 01:08:20.409 --> 01:08:22.670 i would understand sleep deprivation which also 01:08:22.670 --> 01:08:25.770 causes the same kind of thing is that still correct 01:08:25.770 --> 01:08:27.729 with your understanding today and if so yeah 01:08:27.729 --> 01:08:29.550 there's a compounding element between the two 01:08:29.550 --> 01:08:31.609 it's it's very interesting traumatic brain injury 01:08:31.609 --> 01:08:36.000 is of course something that i sort of come across 01:08:36.000 --> 01:08:38.960 because of my involvement with Blind Veterans 01:08:38.960 --> 01:08:41.960 UK. And in fact, their collaboration with Blind 01:08:41.960 --> 01:08:47.119 Veterans USA. And it's one of the most common 01:08:47.119 --> 01:08:50.880 features that occur, I mean, disrupted sleep 01:08:50.880 --> 01:08:53.760 and circadian rhythms after traumatic brain injury. 01:08:53.939 --> 01:08:56.939 And it kind of makes sense because what you're 01:08:56.939 --> 01:09:00.720 doing is... is insulting the brain you're changing 01:09:00.720 --> 01:09:03.199 the pattern of neurotransmitter release at some 01:09:03.199 --> 01:09:06.220 level and that's almost certainly going to impact 01:09:06.220 --> 01:09:08.939 upon sleep at some level so it's not dissimilar 01:09:08.939 --> 01:09:11.319 to the sort of mental health state where you've 01:09:11.319 --> 01:09:13.939 got these overlapping circuits if you screw one 01:09:13.939 --> 01:09:16.840 up which predisposes you to mental health issues 01:09:16.840 --> 01:09:19.170 it's going to predisposure to sleep and circadian 01:09:19.170 --> 01:09:21.930 disruption, and any other insult to the brain. 01:09:22.050 --> 01:09:25.869 So traumatic brain injury is clearly an area. 01:09:26.390 --> 01:09:28.569 Another one, of course, is neurodevelopmental 01:09:28.569 --> 01:09:34.090 problems in children, which are completely disastrous 01:09:34.090 --> 01:09:39.489 to family life because the child often doesn't 01:09:39.489 --> 01:09:42.590 sleep at night or will wake very frequently, 01:09:42.750 --> 01:09:46.199 disrupting the sleep of the entire family unit. 01:09:46.380 --> 01:09:50.800 So yeah, you know, it's interesting that one 01:09:50.800 --> 01:09:55.659 could perhaps argue that good sleep, and of course 01:09:55.659 --> 01:09:57.899 good sleep could be defined in a variety of ways, 01:09:58.020 --> 01:10:00.260 and of course it's very variable between individuals, 01:10:00.420 --> 01:10:03.199 but let's just, you know, use the term good sleep, 01:10:03.239 --> 01:10:08.939 could be used as a metric for overall brain health. 01:10:09.870 --> 01:10:13.069 And so, yeah, TBI, I think, is a serious issue. 01:10:13.210 --> 01:10:16.130 And currently, we don't have a lot that we can 01:10:16.130 --> 01:10:21.590 do. I mean, what the knee jerk reflects for all 01:10:21.590 --> 01:10:26.229 of these things is, well, sedatives. That's tricky. 01:10:26.409 --> 01:10:28.750 One, they don't provide a biological mimic of 01:10:28.750 --> 01:10:31.590 sleep. They sedate the brain. And so some of 01:10:31.590 --> 01:10:36.429 the valuable things going on are actually. are 01:10:36.429 --> 01:10:38.710 lost. So memory consolidation, the processing 01:10:38.710 --> 01:10:42.510 of information by dead drugs or whatever. Same 01:10:42.510 --> 01:10:46.609 with alcohol. If people self -medicate, alcohol 01:10:46.609 --> 01:10:50.029 is a sedative. These things are really very bad. 01:10:51.369 --> 01:10:54.430 Short -term use, of course, of sedatives is okay, 01:10:54.550 --> 01:10:56.630 but it's where you become completely dependent 01:10:56.630 --> 01:11:01.329 upon them. You know, I think for TBI, what we 01:11:01.329 --> 01:11:04.050 sort of recommend is that you just try and use 01:11:04.050 --> 01:11:07.869 good sleep education, good sleep hygiene, which 01:11:07.869 --> 01:11:11.310 is what's detailed in Lifetime, my book, and 01:11:11.310 --> 01:11:13.890 of course, other books as well. And it's sort 01:11:13.890 --> 01:11:17.369 of getting that, you know, during the day, you 01:11:17.369 --> 01:11:19.590 know, getting sufficient light exposure, you're 01:11:19.590 --> 01:11:22.170 exercising appropriately, you're not napping. 01:11:22.590 --> 01:11:26.750 too close to bedtime. You're trying to transition 01:11:26.750 --> 01:11:30.970 from wake to sleep in a sensible way. Meditation, 01:11:30.970 --> 01:11:34.170 mindfulness can be useful for some. Yoga, exercise 01:11:34.170 --> 01:11:40.289 for others. You are not using electronic devices 01:11:40.289 --> 01:11:42.989 immediately before you go to bed because of the 01:11:42.989 --> 01:11:45.189 alerting effect. It's all those sorts of things 01:11:45.189 --> 01:11:52.069 that you can do to support. your biology that 01:11:52.069 --> 01:11:56.090 promotes sleep and circadian rhythm health well 01:11:56.090 --> 01:11:59.210 i think that's another very unethical thing that 01:11:59.210 --> 01:12:01.170 a lot of those sleep aids have been titled sleep 01:12:01.170 --> 01:12:04.350 aids i mean i think again kirk talked about there's 01:12:04.350 --> 01:12:08.609 a correlation with premature death through sleep 01:12:08.609 --> 01:12:11.350 deprivation and through ambient addiction, if 01:12:11.350 --> 01:12:13.909 I got that right. And so, you know, these people 01:12:13.909 --> 01:12:15.189 are thinking they're getting sleep and they're 01:12:15.189 --> 01:12:17.989 not. And I know the absolute crutch in a lot 01:12:17.989 --> 01:12:21.909 of our professions when it comes to a perception 01:12:21.909 --> 01:12:25.369 of deregulation is alcohol. So you take a sleep 01:12:25.369 --> 01:12:27.210 deprived responder, then they go home and have 01:12:27.210 --> 01:12:29.329 a few beers, even if they're not, you know, quote 01:12:29.329 --> 01:12:31.869 unquote, an alcoholic. Now you're destroying 01:12:31.869 --> 01:12:33.989 their sleep that night and then the following 01:12:33.989 --> 01:12:36.390 night and now they're back into it. So they think 01:12:36.390 --> 01:12:38.430 they're missing missing good sleep one every 01:12:38.430 --> 01:12:40.609 three days and they may be missing every single 01:12:40.609 --> 01:12:43.789 night. Exactly. And I think that that that's 01:12:43.789 --> 01:12:46.569 such an important point. And again, it's all 01:12:46.569 --> 01:12:48.949 part of the sleep education. You know, really, 01:12:49.050 --> 01:12:51.909 it's really it's. But as you know, because you've 01:12:51.909 --> 01:12:54.390 been at the front line, it's really difficult 01:12:54.390 --> 01:12:57.010 to get people on board. I mean, you know, after 01:12:57.010 --> 01:12:59.869 a hellish time and you need to relax and wind 01:12:59.869 --> 01:13:02.909 down, the easiest thing for most of us to do. 01:13:02.949 --> 01:13:05.689 And I I'm the same, you know, is to have a whiskey 01:13:05.689 --> 01:13:08.869 or a beer or something to wind you down now. 01:13:09.199 --> 01:13:11.979 A small whiskey or a beer is fine, but it's where 01:13:11.979 --> 01:13:15.140 you're using it actively as a sedative. I mean, 01:13:15.159 --> 01:13:17.340 I actually spoke to somebody the other day, and 01:13:17.340 --> 01:13:20.880 of course, Phenagon is one of these antihistamines 01:13:20.880 --> 01:13:23.579 that passes the blood -brain barrier and can 01:13:23.579 --> 01:13:27.779 cause incredible sleepiness. And stuff you can 01:13:27.779 --> 01:13:30.880 buy over the counter because it's basically just 01:13:30.880 --> 01:13:34.560 an antihistamine. And people are self -medicating 01:13:34.560 --> 01:13:37.819 on things like that. And that can be a real insult. 01:13:39.000 --> 01:13:41.640 I thought I'd try it one day just to see, you 01:13:41.640 --> 01:13:44.180 know, as you do. And I thought, you know, there's 01:13:44.180 --> 01:13:46.699 all this talk about ferrigan. And I took it on 01:13:46.699 --> 01:13:48.760 a Friday evening and I was wiped out the next 01:13:48.760 --> 01:13:51.539 day. I mean, it really had. And that's one of 01:13:51.539 --> 01:13:54.199 the problems of these sedatives, because not 01:13:54.199 --> 01:13:56.939 only do they not provide a biological mimic for 01:13:56.939 --> 01:13:59.319 sleep, but they generate daytime sleepiness. 01:13:59.699 --> 01:14:02.720 And so that's why they're never. prescribed or 01:14:02.720 --> 01:14:05.180 they should never be prescribed for the elderly 01:14:05.180 --> 01:14:07.640 or indeed individuals with dementia because it 01:14:07.640 --> 01:14:10.939 kind of makes it worse so i want to hit on one 01:14:10.939 --> 01:14:13.340 more topic before we go to jet lag and then kind 01:14:13.340 --> 01:14:16.060 of round this up but um another thing that i 01:14:16.060 --> 01:14:18.600 see in my profession um it's kind of a double 01:14:18.600 --> 01:14:21.909 -edged sword in the men young men like you know 01:14:21.909 --> 01:14:24.470 in their 30s a few years into their career i'm 01:14:24.470 --> 01:14:27.729 seeing an absolute epidemic now of uh use of 01:14:27.729 --> 01:14:30.470 exogenous testosterone and when when we hear 01:14:30.470 --> 01:14:32.770 about the you know the levels that these men 01:14:32.770 --> 01:14:34.750 are reporting from their annual physicals they're 01:14:34.750 --> 01:14:37.460 absolutely in the toilet I don't know if there's 01:14:37.460 --> 01:14:39.159 a direct correlation or indirect correlation, 01:14:39.380 --> 01:14:42.960 but I'm also seeing what appears to be an inability 01:14:42.960 --> 01:14:46.460 to conceive as well, far reduced fertility levels. 01:14:46.579 --> 01:14:48.920 So I'd love to hear your thoughts on those. Well, 01:14:49.060 --> 01:14:51.579 yeah, I mean, absolutely. Not only will testosterone 01:14:51.579 --> 01:14:55.399 change sort of behavior, make individuals more 01:14:55.399 --> 01:14:58.760 aggressive. There's good evidence for that. But 01:14:58.760 --> 01:15:01.260 also high levels of testosterone will reduce 01:15:01.260 --> 01:15:04.420 fertility. So there's that's that's that's a 01:15:04.420 --> 01:15:07.399 yeah. I mean. What's also interesting, if we 01:15:07.399 --> 01:15:09.079 think about women, I know there aren't that many 01:15:09.079 --> 01:15:11.880 women in the fire service, but I mean, women 01:15:11.880 --> 01:15:14.460 doing shift work generally because of the importance 01:15:14.460 --> 01:15:17.359 of the circadian system in the regulation of 01:15:17.359 --> 01:15:19.539 the menstrual cycle. And it's at every level. 01:15:19.579 --> 01:15:21.560 It's the hormone release at the level of the 01:15:21.560 --> 01:15:24.739 hypothalamus. It's the pituitary release of the 01:15:24.739 --> 01:15:27.500 hormones that regulate the ovary, that regulate 01:15:27.500 --> 01:15:29.840 the sort of the receptors that respond. I mean, 01:15:29.859 --> 01:15:33.250 every level. you have the role of a circadian 01:15:33.250 --> 01:15:35.689 clock and shift work has been associated with 01:15:35.689 --> 01:15:38.949 reduced levels of fertility and higher rates 01:15:38.949 --> 01:15:44.310 of spontaneous abortion. So, yeah, it's certainly 01:15:44.310 --> 01:15:47.689 taking the exogenous testosterone in men would 01:15:47.689 --> 01:15:53.130 reduce fertility, actually might even cause testis 01:15:53.130 --> 01:15:59.000 to reduce in size. And in women. even without 01:15:59.000 --> 01:16:03.319 taking exogenous hormones, the menstrual cycle 01:16:03.319 --> 01:16:08.439 can be profoundly disrupted by night shift work. 01:16:09.380 --> 01:16:11.000 Well, thank you for that. Because I think these 01:16:11.000 --> 01:16:12.939 are things that we never hear that I think are 01:16:12.939 --> 01:16:15.340 very important. Because the understanding that 01:16:15.340 --> 01:16:17.380 improved sleep could elevate that testosterone 01:16:17.380 --> 01:16:20.819 again is not on anyone's lips. And sadly, there's 01:16:20.819 --> 01:16:24.479 an entire industry at the moment praying. on 01:16:24.479 --> 01:16:27.220 tired people and telling them that this exogenous 01:16:27.220 --> 01:16:29.380 testosterone is a magic pill and then ultimately 01:16:29.380 --> 01:16:31.619 you're it's another band -aid it's not actually 01:16:31.619 --> 01:16:34.399 addressing the root cause absolutely no i would 01:16:34.399 --> 01:16:36.779 i would strongly advise and of course and of 01:16:36.779 --> 01:16:38.600 course you can get testosterone i guess just 01:16:38.600 --> 01:16:41.819 just online um but if you were to talk to your 01:16:41.819 --> 01:16:45.720 general practitioner they would overwhelmingly 01:16:45.720 --> 01:16:49.439 strongly um urge you not to do it because it 01:16:49.439 --> 01:16:53.329 does have you know serious side effects So I 01:16:53.329 --> 01:16:56.850 want to get to the round the world thing that 01:16:56.850 --> 01:16:58.590 I'm about to do and get your perspective on that. 01:16:58.630 --> 01:17:01.630 But before we do, circling around to the Blind 01:17:01.630 --> 01:17:04.390 Veterans UK, talk to me about, because I'd never 01:17:04.390 --> 01:17:06.890 really thought about this, you have some blindness 01:17:06.890 --> 01:17:09.210 where the eye is still intact and some blindness 01:17:09.210 --> 01:17:11.069 where through trauma the eye has been destroyed. 01:17:11.510 --> 01:17:15.130 So talk to me about the circadian rhythm disruptions 01:17:15.130 --> 01:17:17.130 that some of our veterans receive through their 01:17:17.130 --> 01:17:20.390 service and then the chronopharmacology that 01:17:20.390 --> 01:17:22.050 potentially could help some of these men and 01:17:22.050 --> 01:17:25.590 women. So because of the discovery of this other 01:17:25.590 --> 01:17:28.529 photoreceptor system within the eye, it's now 01:17:28.529 --> 01:17:31.550 become clear that the eye is both the organ of 01:17:31.550 --> 01:17:35.350 space because of vision, but it's also the organ 01:17:35.350 --> 01:17:38.350 of time because of its regulation of the internal 01:17:38.350 --> 01:17:42.170 biological clock. And what we discovered in mice 01:17:42.170 --> 01:17:44.609 and then in humans is that if you've got genetic 01:17:44.609 --> 01:17:46.689 diseases which have wiped out the visual cells, 01:17:46.770 --> 01:17:49.229 the rods and the cones, you can still regulate 01:17:49.229 --> 01:17:53.949 your clock. weird photoreceptors, the photosensitive 01:17:53.949 --> 01:17:57.529 retinal ganglion cells are still there and working. 01:17:57.729 --> 01:18:02.329 So one really important issue is that clinical 01:18:02.329 --> 01:18:06.569 ophthalmologists now need to make sure that they're 01:18:06.569 --> 01:18:10.449 giving the appropriate advice to those visually 01:18:10.449 --> 01:18:13.329 blind individuals. There has been a tendency, 01:18:13.550 --> 01:18:15.050 well, if you're visually blind, well, the eyes 01:18:15.050 --> 01:18:18.510 are no use to you. But actually, circadian regulation 01:18:18.510 --> 01:18:21.770 could be preserved so they need to look at that 01:18:21.770 --> 01:18:24.869 and indeed people with no vision should be still 01:18:24.869 --> 01:18:28.069 encouraged to get out if it's not going to cause 01:18:28.069 --> 01:18:30.869 any further eye damage get sufficient light to 01:18:30.869 --> 01:18:33.130 regulate their clock because otherwise they have 01:18:33.130 --> 01:18:35.970 this double whammy which is of course vision 01:18:35.970 --> 01:18:40.050 blindness which is bad enough But to have also 01:18:40.050 --> 01:18:42.770 lost the ability to regulate your clock, as you 01:18:42.770 --> 01:18:45.689 have if you've lost your eyes completely as a 01:18:45.689 --> 01:18:50.050 result of trauma or indeed disease, then what 01:18:50.050 --> 01:18:52.430 you get is that the clock keeps on ticking. But 01:18:52.430 --> 01:18:54.430 for most humans, the clock is slightly longer 01:18:54.430 --> 01:18:59.449 than 24 hours. So without eyes. we'll get up 01:18:59.449 --> 01:19:01.250 and go to bed a little bit later and later and 01:19:01.250 --> 01:19:04.250 later and later. So you rapidly become completely 01:19:04.250 --> 01:19:07.270 desynchronized with the natural light -dark cycle 01:19:07.270 --> 01:19:09.750 and indeed what your friends, family, and colleagues 01:19:09.750 --> 01:19:13.729 are doing. And some of the discussions I've had 01:19:13.729 --> 01:19:17.590 with individuals with eye loss have been deeply 01:19:17.590 --> 01:19:20.430 moving. I mean, I remember, because these are 01:19:20.430 --> 01:19:24.630 really fantastic individuals, they're very independent, 01:19:24.930 --> 01:19:27.409 fiercely independent. And one chap was saying, 01:19:27.840 --> 01:19:33.619 that he's completely tricked by his body and 01:19:33.619 --> 01:19:36.579 he finds it so irritating. And he was telling 01:19:36.579 --> 01:19:40.239 me of the fact that he knows that the next day 01:19:40.239 --> 01:19:42.439 is a Wednesday and that's the day that he cuts 01:19:42.439 --> 01:19:45.939 the lawn. So he wakes up, has worked out a way 01:19:45.939 --> 01:19:49.119 to go outside, get to the shed, get the lawnmower 01:19:49.119 --> 01:19:51.720 out, work out a way to cut the lawn. I mean, 01:19:51.760 --> 01:19:53.880 you know, ferociously independent, brilliant 01:19:53.880 --> 01:19:57.220 individuals. And then... he realizes because 01:19:57.220 --> 01:19:59.119 the neighbors complain that it's three o 'clock 01:19:59.119 --> 01:20:02.039 in the morning and it's that you know no sense 01:20:02.039 --> 01:20:06.079 of time and and and a chat to and in fact i've 01:20:06.079 --> 01:20:08.859 got some some nice quotes from those individuals 01:20:08.859 --> 01:20:14.039 in the book um and one one was saying i'm slowly 01:20:14.039 --> 01:20:17.300 becoming more and more isolated it feels like 01:20:17.300 --> 01:20:21.819 constant jet lag and so this is a this is a really 01:20:21.819 --> 01:20:26.640 profound issue so So why we're collaborating 01:20:26.640 --> 01:20:30.380 is that because of our interest in how light 01:20:30.380 --> 01:20:34.399 regulates the internal clock, we've sort of found 01:20:34.399 --> 01:20:37.779 new receptors. We've now discovered the molecular 01:20:37.779 --> 01:20:40.560 and signaling pathways whereby those receptors 01:20:40.560 --> 01:20:43.479 interact with the molecular clock. And we've 01:20:43.479 --> 01:20:45.739 got one drug, we've got four in development, 01:20:45.880 --> 01:20:48.399 but one is quite advanced and is actually just 01:20:48.399 --> 01:20:51.439 completing its first in human trials now. And 01:20:51.439 --> 01:20:55.680 that will look at its toxicity and dose strength. 01:20:56.140 --> 01:20:59.800 And then we'll work on healthy humans. And then 01:20:59.800 --> 01:21:02.880 we'll work on individuals with complete blindness. 01:21:02.899 --> 01:21:05.439 So we've worked it all out before we get to our 01:21:05.439 --> 01:21:08.079 blind individuals. And the point there will be 01:21:08.079 --> 01:21:11.779 you can take this drug. the clock will be fooled 01:21:11.779 --> 01:21:14.859 that it's seen light. And therefore you can stabilize 01:21:14.859 --> 01:21:18.819 the sleep weight pattern. And so if I can end 01:21:18.819 --> 01:21:21.649 my career. by giving back a sense of biological 01:21:21.649 --> 01:21:25.689 time to those individuals, I'll finish very, 01:21:25.789 --> 01:21:29.810 very happy because it's such a debilitating and 01:21:29.810 --> 01:21:32.130 appalling. We all know what jet lag is like, 01:21:32.189 --> 01:21:35.250 but just imagine having it constantly for the 01:21:35.250 --> 01:21:37.310 rest of your life and the social isolation it 01:21:37.310 --> 01:21:39.529 causes, the fact that it's bad enough to try 01:21:39.529 --> 01:21:42.529 and maintain a job if you have no vision. But 01:21:42.529 --> 01:21:44.729 trying to maintain a job when you have no vision 01:21:44.729 --> 01:21:49.510 and you have no sense of biological time is insurmountable. 01:21:49.970 --> 01:21:51.930 So no, they're extraordinary individuals. And 01:21:51.930 --> 01:21:56.069 I'm actually, because of the preclinical data 01:21:56.069 --> 01:21:58.050 we've got, I'm confident we can do it. I mean, 01:21:58.069 --> 01:22:00.510 we know what the pathway is. We know what the 01:22:00.510 --> 01:22:02.590 pathway light activates. And we know that this 01:22:02.590 --> 01:22:08.329 drug activates the same pathway. So I'm 95 % 01:22:08.329 --> 01:22:11.210 sure we'll nail it, which will be, as I say, 01:22:11.250 --> 01:22:13.840 fantastic. That's amazing. It seems like when 01:22:13.840 --> 01:22:15.899 we think about veterans, and I've had a lot of 01:22:15.899 --> 01:22:19.180 people on here, I'm actually about to get a gentleman 01:22:19.180 --> 01:22:20.880 who's blind. He's not a veteran, but he's blind. 01:22:20.939 --> 01:22:23.380 He's actually a downhill mountain bike racer, 01:22:23.380 --> 01:22:26.100 and he uses some sort of sonar. I haven't spoken 01:22:26.100 --> 01:22:28.279 to him yet, but it's pretty incredible, so I'm 01:22:28.279 --> 01:22:30.739 looking forward to that. But we don't think so 01:22:30.739 --> 01:22:32.899 much of our veterans that lost their vision, 01:22:33.020 --> 01:22:36.100 that they're not as sexy as someone with a couple 01:22:36.100 --> 01:22:41.350 of prostheses on. The challenges mentally for 01:22:41.350 --> 01:22:43.729 losing your vision, as you said, losing that 01:22:43.729 --> 01:22:47.250 interaction, adding the mental health impacts 01:22:47.250 --> 01:22:50.489 of the trauma itself, of the TBI, and then you 01:22:50.489 --> 01:22:53.210 take that circadian rhythm disruption as well. 01:22:53.470 --> 01:22:56.770 I mean, most of us couldn't even think about 01:22:56.770 --> 01:22:59.300 it. Yes, so no wonder the health in this particular 01:22:59.300 --> 01:23:03.319 sector, you know, levels of depression, very 01:23:03.319 --> 01:23:07.560 high, coronary heart disease, diabetes to obesity, 01:23:07.760 --> 01:23:12.159 all the things that you see at a higher frequency 01:23:12.159 --> 01:23:14.619 in this sector, which are dismissed as, oh, well, 01:23:14.680 --> 01:23:17.640 that's kind of because they... can't see the 01:23:17.640 --> 01:23:20.880 world, not because of circadian rhythm disruption. 01:23:21.079 --> 01:23:24.260 Same incidentally in mental health. I mean, the 01:23:24.260 --> 01:23:27.060 life expectancy of individuals with severe mental 01:23:27.060 --> 01:23:30.800 illness is very much shortened, up to 25 years 01:23:30.800 --> 01:23:34.500 in some cases. And what do they have? Coronary 01:23:34.500 --> 01:23:38.239 heart disease, you know, cancer. all of those 01:23:38.239 --> 01:23:41.420 sorts of features. And it's recognized, but it's 01:23:41.420 --> 01:23:44.939 never considered as the product of the sleep 01:23:44.939 --> 01:23:47.779 and circadian rhythm disruption. It's just either, 01:23:47.859 --> 01:23:50.000 well, that's kind of what you get on these medications, 01:23:50.079 --> 01:23:53.460 or this is what you have to endure. And of course, 01:23:53.500 --> 01:23:57.239 you don't. You can stabilize sleep -wake in these 01:23:57.239 --> 01:24:00.020 conditions, at least partially using cognitive 01:24:00.020 --> 01:24:03.960 behavioral therapy and mitigate some of these 01:24:03.960 --> 01:24:07.609 terrible health issues. It's amazing. Well, speaking 01:24:07.609 --> 01:24:11.229 of veterans, I am about to embark on a journey 01:24:11.229 --> 01:24:14.170 with a Navy SEAL friend of mine. He and some 01:24:14.170 --> 01:24:18.109 other special operations men, and then there's 01:24:18.109 --> 01:24:21.529 a couple of high -level triathletes, are part 01:24:21.529 --> 01:24:24.289 of a year -long longitudinal study. There's a 01:24:24.289 --> 01:24:27.949 ramp up where they're looking at different supplementation, 01:24:27.949 --> 01:24:30.149 training styles, breathing techniques, mental 01:24:30.149 --> 01:24:33.539 health elements. But the pinnacle event is called 01:24:33.539 --> 01:24:36.520 7X. And in February, they're going to be doing 01:24:36.520 --> 01:24:39.880 seven skydives, seven marathons, seven swims 01:24:39.880 --> 01:24:43.520 in seven continents in seven days. So we're basically 01:24:43.520 --> 01:24:45.500 going to land. They're going to do their thing. 01:24:45.619 --> 01:24:47.819 I'm going to be kind of documenting it and being 01:24:47.819 --> 01:24:50.199 support. Then we're going to jump in a plane, 01:24:50.319 --> 01:24:52.380 go to another time zone, do the same thing again. 01:24:52.520 --> 01:24:57.159 So with us circumnavigating the globe, from a 01:24:57.159 --> 01:24:59.840 jet lag perspective, what would be some of the 01:24:59.840 --> 01:25:03.189 tools that you advise? that group of insane individuals 01:25:03.189 --> 01:25:07.350 to include in their toolbox? The first point, 01:25:07.470 --> 01:25:10.090 in fact, one of the big papers we published a 01:25:10.090 --> 01:25:13.250 few years ago actually explains how we get jet 01:25:13.250 --> 01:25:15.189 lag. We've actually identified a protein. So 01:25:15.189 --> 01:25:17.789 when you travel across to a new light -dark cycle, 01:25:17.850 --> 01:25:21.270 a new time zone, why does it take a day for every 01:25:21.270 --> 01:25:23.949 time zone you've crossed to adapt? Why don't 01:25:23.949 --> 01:25:26.229 we adapt immediately? And we discovered that 01:25:26.229 --> 01:25:30.460 this protein is turned on and actually... turns 01:25:30.460 --> 01:25:36.300 the light input pathway off. And so it limits, 01:25:36.439 --> 01:25:38.520 it acts as a brake on the effects of light on 01:25:38.520 --> 01:25:41.560 the clock. So that's not particularly helpful. 01:25:42.079 --> 01:25:43.840 Actually, it was quite interesting. When I met 01:25:43.840 --> 01:25:47.699 Prince William a few years ago, he had obviously 01:25:47.699 --> 01:25:51.260 been briefed. And it was quite funny because 01:25:51.260 --> 01:25:53.779 he said to me, he said, what do I do about jet 01:25:53.779 --> 01:25:55.579 lag? And I said, well, the good news, sir, is 01:25:55.579 --> 01:25:59.060 that We understand the fundamental mechanisms 01:25:59.060 --> 01:26:02.699 of jet lag, and we can cure it in a mouse. The 01:26:02.699 --> 01:26:05.100 problem is we can't quite do it yet in humans. 01:26:05.220 --> 01:26:08.340 It's a roar of laughter. And it's true. I mean, 01:26:08.359 --> 01:26:10.300 I think that we will be able to do it because 01:26:10.300 --> 01:26:13.239 actually, if we can get an inhibitor to that 01:26:13.239 --> 01:26:15.819 protein, we'll take the brake off the effects 01:26:15.819 --> 01:26:17.199 of light on the clock, and then you'll be able 01:26:17.199 --> 01:26:18.659 to adapt. And that's what we've done with mice. 01:26:19.770 --> 01:26:22.810 And so what can we do now, which is the key thing? 01:26:22.890 --> 01:26:24.909 Well, the first point to really emphasize is 01:26:24.909 --> 01:26:27.869 it takes a day for every time zone you've crossed 01:26:27.869 --> 01:26:32.489 to adapt. So if it's seven time zones, it's seven 01:26:32.489 --> 01:26:38.329 days at least. And some people a little bit shorter, 01:26:38.430 --> 01:26:41.189 some people a little bit faster. Melatonin will 01:26:41.189 --> 01:26:44.810 have a very mild effect. So don't rely on melatonin. 01:26:45.289 --> 01:26:48.140 It's often missed. completely inappropriately 01:26:48.140 --> 01:26:50.779 called a sleep hormone. It is not a sleep hormone. 01:26:50.979 --> 01:26:54.579 It's a very mild modulator. And there's a lot 01:26:54.579 --> 01:26:57.380 of nonsense talked about melatonin, sadly, and 01:26:57.380 --> 01:26:59.920 a lot of misinformation out there. So, okay, 01:27:00.000 --> 01:27:03.000 what can we do now? Rule of thumb is quite straightforward. 01:27:03.300 --> 01:27:08.880 If we're traveling west, then you seek out the 01:27:08.880 --> 01:27:12.020 light in the new time zone. And that will mean 01:27:12.020 --> 01:27:16.899 you'll adapt faster. If you're... traveling east 01:27:16.899 --> 01:27:18.920 it's a bit more complicated if you're traveling 01:27:18.920 --> 01:27:23.899 more than six time zones avoid morning light 01:27:23.899 --> 01:27:26.800 for the first few days in the time zone that 01:27:26.800 --> 01:27:30.140 you're going to dark glasses or whatever and 01:27:30.140 --> 01:27:34.380 seek out afternoon late afternoon light i won't 01:27:34.380 --> 01:27:36.939 go into the reasons why but it's based on solid 01:27:36.939 --> 01:27:40.939 science and so really traveling east is much 01:27:40.939 --> 01:27:44.220 more of a problem for most of us And part of 01:27:44.220 --> 01:27:46.319 the problem is that we tend to hit the clock 01:27:46.319 --> 01:27:48.960 at the wrong time in the new time zone, which 01:27:48.960 --> 01:27:52.579 instead of dragging us forward, it can actually 01:27:52.579 --> 01:27:55.600 push us back. So when we see light is actually 01:27:55.600 --> 01:27:58.260 rather important. But that rule of thumb, traveling 01:27:58.260 --> 01:28:00.779 west, seek light out, traveling east more than 01:28:00.779 --> 01:28:03.460 six time zones, then it's avoid morning light 01:28:03.460 --> 01:28:06.520 and seek out afternoon, late afternoon light. 01:28:06.579 --> 01:28:08.840 And that will help you adapt better. And that's 01:28:08.840 --> 01:28:13.670 what I do. However, I'm just amazed at what you 01:28:13.670 --> 01:28:15.529 guys are going to be doing. I mean, I find it 01:28:15.529 --> 01:28:17.069 difficult not to get out of bed in the morning, 01:28:17.109 --> 01:28:20.729 let alone jump from planes and, you know, do 01:28:20.729 --> 01:28:23.729 it all of that stuff. It's extraordinary. You're 01:28:23.729 --> 01:28:26.329 crazy. Yeah, well, they're doing it. Like I said, 01:28:26.369 --> 01:28:28.850 I'm supporting, but it is an interesting thing 01:28:28.850 --> 01:28:30.970 because if you think about it, as you've got 01:28:30.970 --> 01:28:33.270 that progressive sleep deprivation and they're 01:28:33.270 --> 01:28:35.369 doing, some of them are base jumpings. They're 01:28:35.369 --> 01:28:38.800 jumping off a building. Yeah. And I think actually 01:28:38.800 --> 01:28:40.819 on a serious note is that they need to know. 01:28:41.000 --> 01:28:43.899 I mean, the problem, we sort of touched on this 01:28:43.899 --> 01:28:45.359 earlier, but I think it's worth emphasizing it. 01:28:45.380 --> 01:28:47.380 The tired brain is so tired it can't detect how 01:28:47.380 --> 01:28:50.579 tired it is. And so it does stupid unreflective 01:28:50.579 --> 01:28:53.760 things thinking it's OK. So you need to tell 01:28:53.760 --> 01:28:58.880 these guys that actually you really need to assess 01:28:58.880 --> 01:29:01.819 the dangers and the problems and the potential 01:29:01.819 --> 01:29:04.979 risks. Seriously, because you're going to be 01:29:04.979 --> 01:29:07.500 more impulsive. You're going to be less sort 01:29:07.500 --> 01:29:10.720 of reflective. And so, for goodness sake, think 01:29:10.720 --> 01:29:15.119 about this as they get more and more tired. And 01:29:15.119 --> 01:29:17.779 their reflexes will also change. Also, if they're 01:29:17.779 --> 01:29:19.720 spending a lot of time with each other, they're 01:29:19.720 --> 01:29:21.340 going to start to find each other irritable. 01:29:22.100 --> 01:29:24.119 Oh, yeah, I can see that, too. Suck on a plane 01:29:24.119 --> 01:29:27.470 for seven days straight. just it's yeah nightmare 01:29:27.470 --> 01:29:29.789 now the whole point of this though at the end 01:29:29.789 --> 01:29:31.510 of it there's going to be a reboot phase and 01:29:31.510 --> 01:29:33.949 they're writing a manual for military and first 01:29:33.949 --> 01:29:36.550 responders on you know, a lot of the science 01:29:36.550 --> 01:29:38.930 that works. The pinnacle event, of course, is 01:29:38.930 --> 01:29:42.050 a pseudo -shiny object. The whole foundation 01:29:42.050 --> 01:29:44.010 of this is a fundraiser for their non -profits 01:29:44.010 --> 01:29:46.750 for burn -injured and mental health issues in 01:29:46.750 --> 01:29:48.569 the first responder and military professions. 01:29:48.970 --> 01:29:50.970 So there's an altruistic, you know, reason for 01:29:50.970 --> 01:29:54.590 it. No, I think that's wonderful. But do, you 01:29:54.590 --> 01:29:58.369 know, it's not without some danger, obviously. 01:29:58.750 --> 01:30:00.930 And they just need to be, again, it's that educational 01:30:00.930 --> 01:30:05.399 piece. Just, you know, their metabolism, their 01:30:05.399 --> 01:30:07.180 diet, they're going to get hungry at weird times. 01:30:07.340 --> 01:30:10.000 You know, they're just going to, they might again, 01:30:10.119 --> 01:30:12.399 as we've touched on, say, oh, you know, maybe 01:30:12.399 --> 01:30:14.100 I'll just have not just one whiskey tonight, 01:30:14.180 --> 01:30:16.840 but I'll have just a few. And because you become 01:30:16.840 --> 01:30:22.439 just, you slide into a strange metabolic space. 01:30:23.979 --> 01:30:28.199 And so, yeah, just warn them. Beautiful. Well, 01:30:28.260 --> 01:30:31.420 thank you. So your book Lifetime, which I was 01:30:31.420 --> 01:30:33.340 lucky enough. It's funny. My dad sent me a copy 01:30:33.340 --> 01:30:35.539 and it went to my old house. He didn't put my 01:30:35.539 --> 01:30:37.920 new address. So the first one got sent back. 01:30:38.020 --> 01:30:41.159 So I got the second one. But absolutely incredible. 01:30:41.180 --> 01:30:43.340 And the fact that you do focus on shift work 01:30:43.340 --> 01:30:45.020 and some of these areas that, you know, some 01:30:45.020 --> 01:30:47.819 of the other sleep books that are well known 01:30:47.819 --> 01:30:50.840 don't really explore. a lot of the communities 01:30:50.840 --> 01:30:53.520 that are listening at the moment. So I was actually 01:30:53.520 --> 01:30:55.840 blown away by, I think it should be another Bible 01:30:55.840 --> 01:30:58.779 for wellness for everyone, especially if you're 01:30:58.779 --> 01:31:01.180 a shift worker though. So tell me about what 01:31:01.180 --> 01:31:02.800 made you write the book and then where people 01:31:02.800 --> 01:31:08.939 can find it. There were two motivations. One 01:31:08.939 --> 01:31:13.560 is as an academic working in this space, largely 01:31:13.560 --> 01:31:16.500 paid by public funds. I think it's an absolute 01:31:16.500 --> 01:31:20.590 duty. to get this information out to the broader 01:31:20.590 --> 01:31:22.829 community. It's no good just talking to other 01:31:22.829 --> 01:31:26.310 academics and other people in the know. We have 01:31:26.310 --> 01:31:29.069 an absolute duty to disseminate this knowledge. 01:31:29.289 --> 01:31:31.789 And there aren't that many really good ways you 01:31:31.789 --> 01:31:35.810 can do it. You can do the occasional radio interview, 01:31:35.989 --> 01:31:39.689 but you just need to get all the information 01:31:39.689 --> 01:31:43.930 out there. And so it was that that was the primary 01:31:43.930 --> 01:31:46.710 motivation. And one of the things that I was 01:31:46.710 --> 01:31:50.399 really... pleased about is working with the editors 01:31:50.399 --> 01:31:54.220 at Penguin was that first of all it's fairly 01:31:54.220 --> 01:31:58.579 light in the sense that it hopefully most of 01:31:58.579 --> 01:32:02.260 it is fairly easy to read and it was interesting 01:32:02.260 --> 01:32:04.420 because I would I put in like a little story 01:32:04.420 --> 01:32:06.180 a little anecdote and they said oh this is great 01:32:06.180 --> 01:32:08.399 you know put more of those in because that's 01:32:08.399 --> 01:32:10.479 great it makes it easier to read and as an academic 01:32:11.100 --> 01:32:13.319 You tend to shy away, you know, you don't do 01:32:13.319 --> 01:32:15.840 anecdote, you don't do little stories, but I 01:32:15.840 --> 01:32:19.840 now appreciate that it can make the stuff more 01:32:19.840 --> 01:32:23.840 digestible. I was also thrilled because they 01:32:23.840 --> 01:32:29.220 didn't kick back at all that there are 921 references, 01:32:29.460 --> 01:32:31.659 you know, a significant number of millimetres 01:32:31.659 --> 01:32:35.579 of the book is references. And they're very light 01:32:35.579 --> 01:32:38.760 touch, there's just a small little number. where 01:32:38.760 --> 01:32:42.159 the science is quoted. And the logic behind that 01:32:42.159 --> 01:32:45.539 has been that people can go to the original papers 01:32:45.539 --> 01:32:48.880 or the reviews and they can get more information 01:32:48.880 --> 01:32:52.720 in the topics that they want to explore. I mean, 01:32:52.739 --> 01:32:58.300 a good example of that was a lady wrote to me 01:32:58.300 --> 01:33:00.859 saying, I was really amazed that if you take 01:33:00.859 --> 01:33:03.579 your antihypertensives before you go to sleep 01:33:03.579 --> 01:33:06.039 rather than first thing in the morning, it can 01:33:06.039 --> 01:33:08.800 halve your chances of a stroke and a heart attack 01:33:08.800 --> 01:33:11.720 over a 10 year period. I mean, this is phenomenal. 01:33:12.659 --> 01:33:16.399 And the data are based upon thousands of individuals. 01:33:16.720 --> 01:33:20.619 You know, it's solid data. And she said, I mentioned 01:33:20.619 --> 01:33:22.060 this to my husband. He said, oh, don't be so 01:33:22.060 --> 01:33:24.199 daft. You know, it doesn't matter when you take 01:33:24.199 --> 01:33:25.899 them. She said, well, why don't you just go to 01:33:25.899 --> 01:33:28.930 the reference and check up? the paper. And he 01:33:28.930 --> 01:33:32.109 did. And he said, my God, you're right. And so 01:33:32.109 --> 01:33:36.069 I think it's respecting the reader and empowering 01:33:36.069 --> 01:33:40.170 the reader with this kind of new science. So 01:33:40.170 --> 01:33:42.189 that was the first motivation. The second is 01:33:42.189 --> 01:33:46.010 I was getting increasingly irritated with the 01:33:46.010 --> 01:33:49.130 sort of sergeant majors of sleep screaming, you 01:33:49.130 --> 01:33:51.829 must get eight hours of sleep. You must do this. 01:33:51.930 --> 01:33:55.189 You shouldn't do that. And it missed the whole 01:33:55.189 --> 01:33:59.560 point about. human diversity sleep is a very 01:33:59.560 --> 01:34:03.060 tight dynamic part of our biology and like like 01:34:03.060 --> 01:34:06.399 shoe size one size does not fit all so in the 01:34:06.399 --> 01:34:09.859 healthy range of sleep it can be six hours to 01:34:09.859 --> 01:34:13.340 10 or 11 hours and one chat came up to me before 01:34:13.340 --> 01:34:16.539 lockdown and said i don't get eight hours of 01:34:16.539 --> 01:34:19.800 sleep am i going to die and i said well i can 01:34:19.800 --> 01:34:22.500 tell you for sure you will die uh but it's not 01:34:22.500 --> 01:34:24.739 necessarily because you're not getting eight 01:34:24.739 --> 01:34:26.819 hours of sleep and it's that kind of we've become 01:34:26.819 --> 01:34:28.840 more aware of the importance of sleep at some 01:34:28.840 --> 01:34:31.600 level but it's then made us anxious about it 01:34:31.600 --> 01:34:34.359 and and i think that's been deeply harmful because 01:34:34.359 --> 01:34:36.119 when we get anxious about something we just run 01:34:36.119 --> 01:34:37.960 in the opposite direction we don't take it on 01:34:37.960 --> 01:34:44.699 board um and so um i i hope that I could emphasize 01:34:44.699 --> 01:34:48.340 the fact that it's very variable. The sleep that 01:34:48.340 --> 01:34:53.159 we get will change as we age, will change immensely 01:34:53.159 --> 01:34:56.520 between individuals. The sleep duration, the 01:34:56.520 --> 01:34:59.159 sleep timing, and all this stuff. And I think 01:34:59.159 --> 01:35:02.420 that what we've got to do as individuals is work 01:35:02.420 --> 01:35:06.220 out if we're getting the sleep that we need and 01:35:06.220 --> 01:35:10.779 defend those behaviors. So it's not rocket science. 01:35:11.399 --> 01:35:13.859 Do you feel as though you can cope optimally 01:35:13.859 --> 01:35:16.380 during the day to do the job that you do? I mean, 01:35:16.380 --> 01:35:19.220 do you feel able to cope? Are you dependent upon 01:35:19.220 --> 01:35:21.020 an alarm clock or somebody else to get you out 01:35:21.020 --> 01:35:24.060 of bed? Do you oversleep extensively on free 01:35:24.060 --> 01:35:28.000 days? Do you feel sleepy, irritable, fatigued 01:35:28.000 --> 01:35:32.840 when you are awake? Do you crave caffeinated 01:35:32.840 --> 01:35:36.859 drinks? Do you find yourself doing... impulsive 01:35:36.859 --> 01:35:40.699 and unreflective things and again listening to 01:35:40.699 --> 01:35:44.199 your friends family and colleagues are you showing 01:35:44.199 --> 01:35:48.699 irritability loss of empathy are you doing disinhibited 01:35:48.699 --> 01:35:53.079 stupid and unreflective things and you know that's 01:35:53.079 --> 01:35:55.300 it it's the kind of stuff that our grandparents 01:35:55.300 --> 01:35:57.859 would have told us really it's very straightforward 01:35:57.859 --> 01:36:00.039 and if we listen to ourselves we know whether 01:36:00.039 --> 01:36:01.500 we're getting enough sleep or not we don't need 01:36:01.500 --> 01:36:05.409 a wretched app or somebody screaming at us that 01:36:05.409 --> 01:36:08.369 we've got to get eight hours or whatever. And 01:36:08.369 --> 01:36:11.050 so that was the second motivation, which is to 01:36:11.050 --> 01:36:16.550 make the science accessible, but also de -stress 01:36:16.550 --> 01:36:19.149 this extremely important part of our behaviour. 01:36:20.070 --> 01:36:21.770 Yeah, well, I'm glad you brought that up as well, 01:36:21.829 --> 01:36:23.569 because I see a lot of people with the wearables. 01:36:23.569 --> 01:36:26.829 And of course, there are some that have great 01:36:26.829 --> 01:36:29.210 applications and they motivate a certain personality 01:36:29.210 --> 01:36:32.890 type, definitely. Yeah, I chatted to a couple 01:36:32.890 --> 01:36:36.149 of twins recently, two lads, and they've got 01:36:36.149 --> 01:36:38.270 these devices. And, you know, they ring each 01:36:38.270 --> 01:36:41.149 other every morning and say, oh, yes, how much 01:36:41.149 --> 01:36:45.840 good thing did you get last night? They're competitive 01:36:45.840 --> 01:36:47.960 about their sleep. I mean, yeah, it's just madness. 01:36:48.760 --> 01:36:53.479 Yeah, it's interesting. There's a wonderful scientist 01:36:53.479 --> 01:36:57.979 called Ken Wright, and he's at the University 01:36:57.979 --> 01:37:02.260 of Colorado. And he has a big sleep class. He's 01:37:02.260 --> 01:37:05.000 a university professor. And, you know, there's 01:37:05.000 --> 01:37:06.859 a hundred, I don't know how many kids, but a 01:37:06.859 --> 01:37:09.159 hundred kids in the class. And he asked them, 01:37:09.180 --> 01:37:11.960 who here has ever had a sleep app of any sort? 01:37:12.140 --> 01:37:16.140 And everybody raises their hand. And then he 01:37:16.140 --> 01:37:20.579 says, OK, who now is using a sleep app regularly? 01:37:20.880 --> 01:37:24.100 And about three people put their hand up. You 01:37:24.100 --> 01:37:26.560 know, these are smart kids. They know that they're 01:37:26.560 --> 01:37:29.619 being told nonsense half the time. And in a sense, 01:37:29.720 --> 01:37:34.930 why would you trust? an electronic device that 01:37:34.930 --> 01:37:39.609 has been validated in about 12 California high 01:37:39.609 --> 01:37:44.109 school, you know, university students, when actually 01:37:44.109 --> 01:37:46.430 the best metric of whether we've had a good night's 01:37:46.430 --> 01:37:49.310 sleep is ourselves. Well, that was always weird. 01:37:49.810 --> 01:37:51.750 I'm forgetting the name. I've got his book behind 01:37:51.750 --> 01:37:54.569 me. But one of the men that wrote one of the 01:37:54.569 --> 01:37:56.710 first sleep books in that, it was very interesting 01:37:56.710 --> 01:37:59.789 because he talked about the actual metric was. 01:38:00.430 --> 01:38:03.590 sleepiness was fatigue and so you know with it 01:38:03.590 --> 01:38:06.090 you know we were so used to millimeters and milliliters 01:38:06.090 --> 01:38:08.090 and you know all these these metrics that are 01:38:08.090 --> 01:38:12.210 measurable but it you know it it's not complicated 01:38:12.210 --> 01:38:14.329 as you said if you feel tired there's probably 01:38:14.329 --> 01:38:17.390 a lack of sleep but actually you raise a good 01:38:17.390 --> 01:38:20.470 point and i think we need to just disentangle 01:38:20.470 --> 01:38:23.890 sleepiness and fatigue so sleepiness is cured 01:38:23.890 --> 01:38:29.350 by sleep simple as that fatigue is lethargy an 01:38:29.350 --> 01:38:33.930 overwhelming sense of tiredness, probably a depressed 01:38:33.930 --> 01:38:40.609 mood. And fatigue can't be cured by having extra 01:38:40.609 --> 01:38:45.409 sleep, usually. And it's an indication of an 01:38:45.409 --> 01:38:48.649 underlying health issue. It's very interesting. 01:38:48.750 --> 01:38:51.949 I spoke to a lady fairly recently, and she has 01:38:51.949 --> 01:38:55.430 an immune problem. and she has terrible fatigue 01:38:55.430 --> 01:38:58.810 she's she's determined she's very active wants 01:38:58.810 --> 01:39:01.930 to do stuff but she just can't during the day 01:39:01.930 --> 01:39:05.390 because she feels so fatigued and so what happens 01:39:05.390 --> 01:39:07.710 is that she gets to sleep and then she wakes 01:39:07.710 --> 01:39:11.930 up and then she's so anxious because of all the 01:39:11.930 --> 01:39:14.329 stuff she's failed to do during the day as a 01:39:14.329 --> 01:39:18.050 result of the fatigue and so fatigue and sleepiness 01:39:18.050 --> 01:39:21.609 can obviously interact but if you're feeling 01:39:22.810 --> 01:39:25.029 and you're sleeping, you know, sufficiently. 01:39:25.409 --> 01:39:28.350 COVID, a classic example, you know, people slept 01:39:28.350 --> 01:39:32.310 longer but still felt fatigued when they were 01:39:32.310 --> 01:39:37.090 awake. And so if fatigue persists, I think you 01:39:37.090 --> 01:39:39.189 need to see your general practitioner to make 01:39:39.189 --> 01:39:41.329 sure that there's no underlying health issue. 01:39:42.510 --> 01:39:44.989 So it's really important to separate sleepiness 01:39:44.989 --> 01:39:47.729 and fatigue. Well, thank you for that. One thing 01:39:47.729 --> 01:39:49.470 I meant to ask you, and I'm just going to squeeze 01:39:49.470 --> 01:39:52.010 it in right at the end here. So I've been out 01:39:52.010 --> 01:39:54.069 of the fire service now for four years. I would 01:39:54.069 --> 01:39:59.289 say definitely still lent into alcohol till not 01:39:59.289 --> 01:40:02.850 even a year ago. So really been a lot more diligent 01:40:02.850 --> 01:40:05.600 now. pulled way way back on alcohol consumption 01:40:05.600 --> 01:40:08.199 that's had a great impact on my caffeine consumption 01:40:08.199 --> 01:40:12.600 um i meditate my my work output still seems to 01:40:12.600 --> 01:40:15.260 be good um but the one thing i'm still struggling 01:40:15.260 --> 01:40:19.479 to shake is brain fog so do you have any kind 01:40:19.479 --> 01:40:22.199 of um advice for people that maybe seem to be 01:40:22.199 --> 01:40:24.020 doing a lot of the right things but maybe missing 01:40:24.020 --> 01:40:25.979 part of the puzzle when it comes to that particular 01:40:25.979 --> 01:40:30.579 symptom yeah brain fog is is not fully understood 01:40:31.199 --> 01:40:33.420 I mean, you know, in some sense, it's a symptom 01:40:33.420 --> 01:40:38.300 of fatigue. And so fatigue can also be generated 01:40:38.300 --> 01:40:45.319 as a result of excessive anxiety. And so I think 01:40:45.319 --> 01:40:49.420 without digging down into the specifics and individual 01:40:49.420 --> 01:40:52.680 details, it's difficult to know what the origins 01:40:52.680 --> 01:40:57.199 of the brain fog might be. It may well be as 01:40:57.199 --> 01:40:59.560 a result of, I mean, I don't know if you've had 01:40:59.560 --> 01:41:03.640 COVID. It could be a long tail from that. A lot 01:41:03.640 --> 01:41:06.220 of people now, it's being appreciated, a lot 01:41:06.220 --> 01:41:09.220 of people are still suffering from a brain fog 01:41:09.220 --> 01:41:13.520 as a result of long COVID. But there are other, 01:41:13.619 --> 01:41:16.640 you know, an immune imbalance, a metabolic imbalance. 01:41:17.100 --> 01:41:19.720 There's lots of other things that could be causing 01:41:19.720 --> 01:41:22.479 brain fog. Some would argue, and I don't know 01:41:22.479 --> 01:41:25.460 how good the data are. is even your gut bacteria 01:41:25.460 --> 01:41:30.159 might be important for brain. I mean, who would 01:41:30.159 --> 01:41:32.560 have thought it that, you know, the bacteria 01:41:32.560 --> 01:41:36.939 in our gut can not only change our metabolic 01:41:36.939 --> 01:41:40.920 status, but there's even evidence that in ways 01:41:40.920 --> 01:41:42.979 we don't understand, they might even affect our 01:41:42.979 --> 01:41:46.079 mood, depending upon the gut bacteria you have. 01:41:46.460 --> 01:41:48.640 And so, you know, other things that people try 01:41:48.640 --> 01:41:53.800 are biotics, you know, changing, you know, augmenting 01:41:53.800 --> 01:41:56.720 their gut bacteria. But as I say, I don't know 01:41:56.720 --> 01:41:59.520 how good those data are. It's not where I would 01:41:59.520 --> 01:42:02.119 have, you know, have much expertise. Now, with 01:42:02.119 --> 01:42:06.140 previous concussions and TBIs, would that be 01:42:06.140 --> 01:42:08.960 also a potential contributor? Absolutely. Yeah, 01:42:09.039 --> 01:42:13.180 yeah, yeah. I mean, you know, it's a big, you 01:42:13.180 --> 01:42:15.779 know, traumatic brain injury is a huge insult. 01:42:16.119 --> 01:42:21.220 And yeah, brain fog could easily be linked to 01:42:21.220 --> 01:42:26.899 the fact that the brain has sort of adjusted. 01:42:27.060 --> 01:42:30.420 It's kind of sometimes rewired itself, but it 01:42:30.420 --> 01:42:34.000 might be slightly different to some of the wiring 01:42:34.000 --> 01:42:37.319 you had before. And so, I mean, the brain is 01:42:37.319 --> 01:42:40.119 remarkable. I mean, as people endlessly say, 01:42:40.239 --> 01:42:42.539 the most complicated structure in the known universe. 01:42:42.760 --> 01:42:46.279 I love that. Particularly when I talk to my astrophysic 01:42:46.279 --> 01:42:49.180 friends, you know, who go on and on about the 01:42:49.180 --> 01:42:51.060 wonders of the universe. Actually, the greatest 01:42:51.060 --> 01:42:52.800 thing in the universe is sitting on top of our 01:42:52.800 --> 01:43:00.199 head. But it's delicate. And so brain fog could 01:43:00.199 --> 01:43:03.380 easily arise from traumatic brain injury. Beautiful. 01:43:03.399 --> 01:43:05.359 Well, thank you. I spent a lot of time with gentlemen 01:43:05.359 --> 01:43:07.140 that were trying to rearrange my face, so that 01:43:07.140 --> 01:43:12.260 could be part of it. All right. Well, so for 01:43:12.260 --> 01:43:15.079 people listening, I know that the American book 01:43:15.079 --> 01:43:17.060 is out or is about to come out. So where can 01:43:17.060 --> 01:43:19.600 people find that? Okay. So they can find it on 01:43:19.600 --> 01:43:21.699 Amazon. Is that the best place? Yeah, I think 01:43:21.699 --> 01:43:24.380 so. Yeah, it's I know it's advertised at the 01:43:24.380 --> 01:43:27.739 moment. So it's, you know, let me let me just 01:43:27.739 --> 01:43:30.600 make sure because the English version and the 01:43:30.600 --> 01:43:32.420 American version have slightly different titles. 01:43:32.460 --> 01:43:35.859 So the American title is Lifetime, Your Body 01:43:35.859 --> 01:43:38.659 Clock, and its essential roles in good health 01:43:38.659 --> 01:43:45.340 and sleep. And it's I think it's coming out 20th, 01:43:45.340 --> 01:43:48.979 19th, 20th of or maybe towards the end of August. 01:43:49.020 --> 01:43:52.060 Yeah. But you can pre -order now. Beautiful. 01:43:52.260 --> 01:43:54.659 Yeah, it's funny. My sister is an editor. She 01:43:54.659 --> 01:43:57.779 works for British television. And she texts me 01:43:57.779 --> 01:43:59.500 and asks me, okay, this is what I want to say, 01:43:59.600 --> 01:44:02.239 but how would I say this for this American audience 01:44:02.239 --> 01:44:05.399 that I'm editing for? And it's fine. I mean, 01:44:05.420 --> 01:44:07.460 your English title should have been fine for 01:44:07.460 --> 01:44:09.939 the American title. It's interesting being an 01:44:09.939 --> 01:44:13.300 expat, seeing the two differences, and sometimes 01:44:13.300 --> 01:44:14.960 they have to kind of phrase it in a different 01:44:14.960 --> 01:44:17.260 way to make it more catchy for one audience or 01:44:17.260 --> 01:44:19.600 the other. And I haven't checked whether they've 01:44:19.600 --> 01:44:22.699 changed the spellings, actually. Getting rid 01:44:22.699 --> 01:44:26.159 of the U's? Behavior has got a U or not. I don't 01:44:26.159 --> 01:44:28.399 know. I haven't checked. It's only just arrived. 01:44:29.840 --> 01:44:31.579 Well, Russell, I just want to say thank you so 01:44:31.579 --> 01:44:33.539 much. I mean, I'm so glad that, you know, my 01:44:33.539 --> 01:44:36.359 dad... brought your work to my attention. And 01:44:36.359 --> 01:44:38.579 I know he was enamored to hear that we were going 01:44:38.579 --> 01:44:39.800 to have this conversation. I'm actually going 01:44:39.800 --> 01:44:41.960 to put it out immediately because I think it's 01:44:41.960 --> 01:44:43.819 so important what you've told us for the people 01:44:43.819 --> 01:44:46.979 that are listening. But we went over. I truly 01:44:46.979 --> 01:44:48.819 appreciate you being so generous with your time 01:44:48.819 --> 01:44:50.859 and coming on the Behind the Shield podcast today. 01:44:51.699 --> 01:44:53.560 It's been a lot of fun, James, and thank you 01:44:53.560 --> 01:44:56.479 for inviting me. And please send my warmest wishes 01:44:56.479 --> 01:45:00.180 to your dad. Tell him that if he can get to Oxford, 01:45:00.319 --> 01:45:03.539 we should have a reunion and a cup of coffee 01:45:03.539 --> 01:45:04.840 or maybe something stronger.