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Welcome to the Behind the Shield podcast. As
always, my name is James Gearing, and this week
it is my absolute honor to welcome on the show
Professor Russell Foster. Now, one of the main
reasons I started this podcast six years ago
was after I started learning about sleep medicine
and the incredible ill effects mentally and physically
through sleep deprivation. So six years later,
I get to sit down with Russell, one of the pioneers
in circadian and sleep medicine. So we discuss
a host of topics from his journey through zoology
into sleep medicine, how sleep deprivation is
causing mental health issues, cancer, obesity,
hormonal disruption, how we can improve the physical
and mental health in our shift workers, and so
much more. Now, before we get to this incredible
conversation, as I say every single week, please
just take a moment, go to whichever app you listen
to this on, subscribe to the show, leave feedback,
and leave a rating. Every five -star rating truly
does elevate this podcast, therefore making it
easier for others to find. And this is a free
library for you, planet Earth. So all I ask in
return is that you help share these incredible
men and women's stories so I can get them to
every single person who needs to hear them. So
with that being said, I introduce to you Professor
Russell Foster. Enjoy. Well, Professor Foster,
I'd love to start by saying thank you so much
for taking the time and coming on the Behind
the Shield podcast today. I'm really delighted
to join you, James. So as an icebreaker. The
reason I know about your work, there's a few
kind of figures in this kind of space. Professor
Andrew Huberman is definitely one of the voices
we hear a lot in this area. But my dad was the
one who educated me on you and your work. And
then since listening, you know, it's absolutely
fascinated me. Sleep has been such an important
topic in my profession. So just starting, how
did you meet my dad and what was the work you
were doing in Imperial College at that time?
Well, the first point, of course, is that it's
a good example of why you should always listen
to your father. Absolutely. He was actually even
on the podcast. We were we were colleagues at
Imperial College in London, and I was at the
University of Virginia for eight years. And we
had three children who were born in the States.
But my wife. She's a lawyer and it was tricky
to find a good slot for her to get back into
work. So one of the reasons we came home was
essentially to get her career, which had been
on hold, kickstarted again. And I joined originally
the biology department in Imperial College because
my background is zoology and comparative biology.
and then was offered a job at the Institute of
Ophthalmology. And somebody in the medical school
said to me, hang on, don't sign anything until
Monday. And then they offered me a very nice
job. In fact, they almost doubled my salary.
It's always good to work for medical departments
rather than departments of biology, because the
medics get paid a lot more. And so my eyes popped
out on Storks, but I'm a reasonable poker player,
so I kept cool about it and moved to the medical
school and set up a small department of molecular
neuroscience and we were then integrating some
of these wonderful discoveries being made in
the neurosciences some of these new techniques
and so really was was pushing hard on how is
the internal biological clock producing these
sort of beautiful 24 -hour circadian rhythms
How is it set by the external world? It's fine
having a clock, which we can use to fine -tune
physiology and behavior, sort of anticipating
the varied demands of the rest activity, the
day -night cycle. But unless it's locked on to
the external world, it's of no value at all.
A classic mismatch would be jet lag, where the
internal day is completely misaligned to the
external day. And we knew that light was critically
important at setting the internal clock. And
the question that we were addressing, and it
was really an incredibly productive period of
time at Imperial, was how can the visual cells
do this? Because what the visual cells do is
grab light for our sense of space and in a sense
forget they've seen light in a fraction of a
second. And it never made sense to me how...
Those visual cells, the rods and cones, could
also be used for the detection of the dawn -dusk
cycle for the regulation of internal time. Because
you need to detect that light over long periods
of time, and it needs to be quite bright. And
so it never really could understand. So we did
some experiments using mice with hereditary retinal
disorders, mice that were visually blind because
they had genetic diseases where their rods and
cones had broken down. but they could regulate
their clock absolutely perfectly. It's not only
they could just do it, they did it with the same
sensitivity as normal mice, you know, with their
rods and cones. And when we cover the eyes, this
ability to regulate the clock by light had gone.
So it sort of led to the conclusion there must
be something else within the eye. There must
be another light sensor within the eye. And when
we first... published some of these data when
we were first of all we it was very difficult
to publish these data because people just didn't
believe it um and i remember giving a talk uh
actually in the states at one of the big vision
meetings and saying these data you know these
rodless countless mice are consistent with the
fact there must be another light sensor within
the eye And some chap at the back of the auditorium
stood up and looked at me, and I thought he was
going to ask a question. And he just said, bullshit,
and walked out. So, yeah, it took us about 10
years to convince the community, the vision community,
that there was something else really exciting
going on in the eye. And, yeah, it was an interesting
time. I mean, we had... We had some terrible
setbacks. I mean, I had one grant that we submitted
to the Eye Institute. In fact, this was stuff
actually at the transition between coming from
the States to the UK. And it was completely destroyed,
absolutely destroyed. And my chairman, Mike Menneker
at University of Virginia, called me into his
office. And I thought, oh, gosh, you know, I'm
going to get a dressing down now. This is kind
of the end of my career. You know, my grant application
has failed. And he said, no, you're right. This
is great stuff. It's great data. Send it to another
part of the funding body. So I sent it to NIMH.
Six months later or so, I got a call saying,
congratulations, Dr. Foster, your grant has come
top of the panel. And I basically had made no
changes to it. It's the same grant. that was
kicked out into the outer darkness with the Eye
Institute. And they said, would you mind if we
copied this grant and took it to the Society
for Neuroscience meeting as an example of how
a research grant should be written? And it was
a really important lesson to have sort of had
in my early career, where basically you keep
on kicking the door until the bug has let you
in. And it was that. I mean, it's often sort
of caricatured as a can -do attitude in the United
States, but it is. And I think it was that spirit
of just, you know, just not being knocked back
and not taking no for an answer, which was a
very, very important lesson. So, yeah, and then
continued with the work at Imperial College.
And it's just sort of... carried on, you know,
starting with mice, then humans, and now working
on drugs, which I guess we can talk about later,
on how to thaw the clock that it's seen light
for people who don't have eyes. Well, I want
to go to the beginning of your timeline, but
just before I do, when you're talking about door
kicking, that was something that I found, really,
the creation of this podcast was founded out
of that absolute death grip onto the way we've
always done it before and so as we touched on
before we started recording as things are starting
to open up with the cancer in the first responder
community there's this death grip on carcinogens
and absolutely that's that's a part of it when
we look at the mental health side there's a death
grip on it's a trauma that we see obesity I mean
all these things that we'll probably unpack in
a bit but And it's been hard because the fire
service, even more so than in the UK, is very,
very siloed. You could have, you know, a city
and a county and those two departments won't
even talk to each other. And then, you know,
the network of the country is the same. So when
you are being ridiculed by some of your community,
being told, well, rods are, you know, for black
and white and cones of a color and that's it.
How did you, I mean, you know, kicking the door
is an analogy, but how did you actually muster
the strength and move the needle against such
inertia in the community that you were working
in? I think, first of all, it's easier when you're
younger because you've got more confidence and
perhaps you're a bit more arrogant. And I think
that helps. But I think it's more than that.
I know it's sort of caricatured, but it's a can
-do attitude. I was surrounded by people who
were enthusiastic. And one of the things that
people said to me before I went to the States
was, your problem, Russell, is you're just too
enthusiastic. And when I got to the States, it
was embraced. And that's how you're supposed
to be. So I was pre -adapted. And I think there's
a very large, unacknowledged... debt that many
European scientists have to their experiences
in the United States. Many of us left the UK
towards the end of the 80s and discovered a new
way of doing science, where enthusiasm was embraced,
where can -do was driven forward. where you were
expected to kick the door. And it wasn't bad.
You didn't sort of curl up in the corner and
sort of think, oh, well, that's it. You actually
got up and you kicked the door. And so when we
returned to places like the UK and other European
countries, we were not prepared to stand up,
not prepared to put up with the old hierarchies
and the old sorts of ways of doing things. And
I think... And I'm very serious about this. I
think the Americans need to know what they've
contributed to world science by training a cohort
of individuals throughout the 80s and 90s. And
they've gone back. And the health of UK science,
for example, I think is very dependent on a lot
of people who went away and then came back and
have. put that energy that they experienced in
the States into the science that we're doing
here. It's a really huge contribution, which
I don't think anybody really appreciates in the
States. So many of us who worked in the States
have great affection for not only the opportunity,
but also the spirit of the country. Yeah, and
I agree completely. When I moved here, I totally
bought into... the American dream, but the original
American dream. You come here, you forge a path
in your own career. You put a roof over your
family's head. Very, very simple. When I arrived
here, it really was right before the big crash.
So the American dream had kind of morphed into
a large house, a jet ski, a Winnebago. So it
was a little distorted, but I think that's it.
That immigration story, that entrepreneurial
spirit, that challenging the system is at the
core of what I got here now the maddening thing
is that's been suppressed a lot in america so
it's about reigniting that fire within this country
itself yes that's what i understand and it's
a it's a great shame because um there are so
many qualities and so much drive but i think
i think again if i might speak freely i mean
i i think the fundamentals of of the united states
are there It may go for a wobble from time to
time, but it will self -correct. And I have every
expectation that those wonderful attitudes will
return and there will be more of perhaps of a
consensus and an appreciation of everybody contributing
to the American way of life. Absolutely. Well,
I'd love to start at the very beginning. I know,
you know, some of your journey as far as higher
education, but tell me where you were born and
tell me a little bit about your family dynamic,
what your parents did and how many siblings.
That's interesting. So I was born in a town called
Aldershot, which is in Hampshire. And Aldershot
is known as the home of the British Army. And
the reason was that my mother had. gone through
the ranks of being a nurse and then a matron
and then was invited to take charge of a home
for socially deprived children preschool so these
are these are kids who were no older than six
between you know and some of them much younger
and so grew up in an environment where there
were children from a very difficult family background
or may have some physical or mental handicaps.
And they were looked after by mum and obviously
a large number of staff in this huge, great old
Victorian house. And so that was what my mum
did. My father was in charge of the pathology
laboratories at British Airways, BOEC as it was
then. So there was always sort of kind of...
vaguely biomedical stuff my father was was a
really great pathologist so he would prepare
lots of specimens and microscopes featured large
and in fact a very I must have picked this up
from him because I desperately, just desperately
wanted my own microscope as a very young kid.
And I think like all of us, we get these little
cast iron microscopes, tiny little thing. And
I remember being very frustrated that when I
looked down at my eyelashes would get in the
way. So as a pragmatist, as a probably a six
or seven or maybe eight year old, I decided to
cut my eyelashes off so it wouldn't get in the
way. And I remember my poor old mum saying to
me, what have you done to your eyelashes? And
I said, I cut them off because they kept on getting
in the way when I was looking down the microscope.
And she was great because what she said was,
well, OK, that might not have been such a smart
thing to do because, of course, eyelashes are
there to protect the eye from things falling
in. So I'd rather you didn't do that again. So
rather than getting shouted at, it was a very
good strategy because she'd already worked out
that if somebody shouts at me or tells me to
do something, then I will do the opposite. But
she was very reasonable and it was a very sound.
And so I completely complied. I've never since
cut my eyelashes off. I can literally see what
you're talking about, too, because I had a microscope
and it was the same thing. There were spiders
everywhere. It was actually my own eyes. And,
you know, you couldn't see that fly proboscis
or B -wing or whatever the slides that we all
looked at as kids. So that was that. But my father
left when I was 11. So complicated times. And
I think as children, one of the protective mechanisms
is to see the world in black and white. And so
basically, I then refused to see my father again.
So never saw him until, you know, and he died
when I was doing my PhD. So it was that sort
of big sort of schism in my early childhood.
I was lucky because I had the most extraordinary
grandparents. And so in a sense, I'd always been
close to them. But they provided an incredible
sense of stability and nurturing. And I mean,
it was remedial. You know, I was in remedial
classes at school. I just lived in my own little
world, my little bubble, looking down my microscopes,
you know, collecting fossils, all that sort of
thing. And I was a good swimmer, really good
swimmer. And so I remember. uh winning i know
i was the captain of the school for the swimming
team and you know just won this gala and the
headmaster came up and said um of course you
do realize russell is an entirely non -academic
child um and uh but my dear old gran she always
sort of no no he's he's he's all right you know
he's bright enough so don't worry about it and
of course um that was one could be more relaxed
i guess in those days because we weren't sort
of constantly being driven forward over the next
hurdle. So there was time to sort of, I guess,
regroup. And there was time to catch up. And
so I went from the bottom of the class to the
top of the class within 18 months. Completely
bizarre. Really fascinating. So, yeah, I mean,
I had that love. Although my parents split up,
I was lucky to have that support from my grandparents,
who I was very close to. And so I had that. And
I know very many people can be terribly affected
by their parents splitting up. It didn't I don't
think had a huge effect on me because I had that
that huge cushioning as well. So, yeah. And then
I went to university and University of Bristol.
And it was so exciting because I then really
met for the first time lots of other nerdy people
like myself. And, you know, it's it's. Part of
the excitement of university, there are many
things, but one of the things is that you can
stay up until the early hours of the morning
just chatting about stuff and things that matter.
And so it was a wonderful time and just got more
and more. I did zoology, so just immersed myself
in the world of biology and then did my PhD in
Bristol and then got the opportunity to do a
little bit of postdocing, but I stayed. I stayed
in Bristol, but actually I spent most of my time
in Holland learning photoreceptor, like, you
know, biochemistry and Germany learning anatomy.
And that was, again, a really formative experience
because you go to another place and you see another
way of doing science. And that sort of, I mean,
I had an extremely rigorous training. It was
pretty brutal. I mean, and my supervisor and
I now. get on incredibly well. I mean, he's been
amazingly supportive throughout my career without
me knowing it half the time. But there were occasions
where we did have some clashes and I won't go
into any particular detail, but we did. And it
was very useful. But part of the reason was he
was just very, very rigorous and would, I remember
when I gave him my first draft of my PhD. thesis.
And Rumi's quite old school. And so it was a
draft. And I thought, well, it's kind of a draft.
And he read this and he said, this is the worst
draft of a PhD thesis I have ever read. It is
even worse than the foreign students. And that
was sort of quite a confidence knock. But then
it was very interesting because another person,
another very good scientist read it and said,
this is great. And in fact, the changes were
that he was well, because basically I didn't
write like he wrote. And so he would rewrite
in his style. And that was another great lesson,
because with with with my team and I'm given
a paper, my first temptation is to rewrite it
in my style. But that's wrong. Basically, as
long as it's coherent and long as it's well structured,
you don't have to have. the same phraseology
or the same sorts of, it can be different. And
so, yeah, that was a good lesson. But anyway,
and then after, and then we had a visitor from
the States, Mike Menica, and we got on really
well. I mean, he was just, he and his wife, Shirley,
both sadly dead now. And he said, why don't you
come over to the States? You know, so I went
over for three months at the end of 87. And it
was just amazing. The generosity. I mean, they
had a car and called Pigweed. And they said,
look, you know, you can use Pigweed. And I stayed
in that place. And it was it was just amazing.
So he said, well, why don't you come back, you
know, become an assistant professor. So got back
and went to university, went to University of
Virginia and spent eight very happy years there
doing a lot of teaching. I learnt. um a great
deal about teaching and my class which was intro
biology 202 um went from 200 students to 700
students i mean we just just exploded and it
was great i mean these are fantastic kids i had
i had a great time um and uh then we came back
to imperial college um first of all biology and
uh then try to get all my stuff funded which
had previously been funded in the States. And
it just kept on hitting the deck. Very interestingly,
incidentally, I wrote, I hope I'm not going to
get anybody into trouble, but I wrote to NIMH
because I had a grant which couldn't leave the
country. And so I wrote saying, look, I've taken
a job at Imperial College. I understand my R101,
cannot leave. And so very regrettably, I'm going
to have to return it. And I sent a fax. And then
I got a call. You can tell how long ago this
was. And then I got a call from this wonderful
chap who I'd worked with, my project manager,
and said, I've destroyed your facts. As far as
I'm concerned, you have an honorary appointment
at the University of Virginia, and that's where
you'll be based. And he said, we want to fund
the best science there is around the world. And
if you are not in the States, well, that's unfortunate,
but we're not going to. take the money back.
Now, actually, officially, he should have done
that. But what that allowed me to do. was to
keep the research going because we got the early
studies in the States and then we could expand
them massively and it was all the string of science
and nature papers that were really came from
the time of Imperial or the first crop but it
was based on early findings that were made in
the States so whilst I was trying to convince
my UK colleagues that we discovered something
important um uh and before the grant funding
kicked in there i had the same exactly the same
problems when i returned to the uk so i had when
i was first in the states nobody believed it
um but but but through this funding we kept the
whole edifice on the tracks And the rest is history.
So walk me through your kind of journey into
chronobiology. And then when did the merger happen
between circadian rhythm studies and the sleep
world? Yeah. So if we go back to the undergraduate
days at Bristol, there's a famous vertebrate
textbook called The Life of the Vertebrates by
J .Z. Young. And I was reading this, as you do,
one evening. And I came across this work on the
lamprey, you know, these really primitive fish
-like creatures, early vertebrates. And it had
a, J .C. Jung talked about this third, this parietal
eye, that they actually have their lateral eyes
and then a photoreceptor actually on top of their
skull. I thought that was just so amazing and
so cool. And I remember it was the second year,
I rushed in. And then started speaking to one
of the professors there and said, look, I really
want to do some work on something like this.
And so we set up my third year project, which
was recording from these third eyes, these pineal
photoreceptors. This was in frogs. And so that
was just so cool, you know, because here's a
structure that is not an eye, but light sensitive
and regulating behavior and biology. And that.
then got me into my PhD work which is how birds
detect the expanding and contracting day length
and use that to regulate their reproductive system
so you know the increasing days of spring are
detected by a weird photoreceptor in birds, believe
it or not, those receptors are actually within
the brain, actually near those cells that are
actually activated to trigger reproduction. So
you've got cells in the hypothalamus, deep in
the brain, which are light sensitive. And at
this point, people say, oh, come on, what are
you talking about? How, you know, no light can
possibly reach the brain. Well, it does. And
we've all done this, illustrated this point.
When kids, because you crawl under the bedclothes
and you put a flashlight to your hand and your
hand glows. So yes, lots of light does penetrate
through tissue. It's scattered and absorbed in
a way which makes it useless for vision. But
as a way of detecting the dawn -dusk cycle, it's
fine. So you've got local light detectors. So
that was the sort of the photoreceptor, which
made... When we started looking at mammals and
how the hell do they do it, because we knew they
didn't have extra retinal photoreceptors, because
if you covered up the eyes, all light responses
were gone. And in fact, mammals are very interesting.
They've gone through what's called a nocturnal
bottleneck. The entire mammalian lineage was
once nocturnal. And so while the ruling reptiles,
the archosaurs, the dinosaurs dominated the daylight
environment, our ancestors were emerging at twilight
from their burrows and then scuttling around.
And of course, nocturnal animals don't have brilliant
vision. And they also have lost extra retinal
photoreceptors. So that's why mammals don't have
it. So making the conceptual leap that there
could be a weird photoreceptor in the eye wasn't
so huge for me because I'd worked on weird photoreceptors
outside the eye. Now, for vision biologists who've
only studied rods and cones and visual responses,
that's why it was such a heresy because they'd
never looked at light responses. other than vision.
And I was looking for a light response which
was regulating the clock. So that was part of
the... it's a great example actually where interesting
discoveries emerge at the interplace between
different disciplines. And if you're siloed in
one particular part of science you tend not...
to think more broadly. You just take a lot of
facts as so -called facts, as read. You don't
question it. But if you come from the outside,
you tend to sort of think about things slightly
differently. So again, that's why it's so important,
I think, in the sciences to break down the barriers
and get people in different areas talking to
each other, because that's now where the exciting
stuff is emerging. So I was always interested
in photoreceptors, and that's why I spent a lot
of my career. Then I was... When I was working
at Charing Cross Hospital, which was the medical
school part of Imperial College, which is where
your dad was, of course, I was in an elevator
with a psychiatrist and said, oh, you work on
sleep, don't you? And I said, well, actually,
I work on circadian rhythms. And he's sort of
oblivious of the subtlety between the difference.
And we'll come back to that later. He said, yeah,
of course, my patients with schizophrenia. They
get up late. They get to bed late. They miss
my clinic and don't have friends because they
don't have a job. And I thought, well, that's
kind of a bit daft. And so that that irritation
triggered a study, which is the one of the first
studies on the sleep wake cycles and circadian
rhythms of individuals of the diagnosis of schizophrenia.
And that got me into human research. And and
in fact. Just sort of parenthetically, those
rhythms that we saw in those severe cases of
mental health, the rhythms weren't just bad,
they were smashed. I mean, I have never seen
such disrupted sleep -wake cycles in anything
else. I mean, these were profound and it made
a huge impact on me. And so that started a parallel
set of studies. on humans. And so now I sort
of span human studies and animal studies. But
you asked, so what about sleep and circadian
rhythms? And so in the early days, those of us
who went to circadian rhythm meetings were comparative
biologists. There were people working on plants
and pigeons and reptiles and maybe a few people
working on mice. And we were just kind of zoologists
and botanists interested in rhythmicity. We never
thought about sleep. Where sleep has its origins
is in medicine. And it's medics sticking electrodes
onto the surface of the skin on the scalp, recording
the electroencephalogram and looking at how the
EEG. with different sorts of states and conditions.
You have non -REM and REM sleep and all the rest
of it. But we didn't go to the same meetings.
But then as we had a greater understanding of
the role of circadian rhythms in the regulation
of sleep, and as the neuroscience of sleep became
much clearer, it was... crazy to many of us to
think that sleep should be considered as distinct.
It's another 24 -hour phenomenon. It's complicated,
but at its heart, one could argue, is the regulation
by the circadian system. So now I feel comfortable
working, you know, saying that I'm both a circadian
and a sleep researcher. And in fact, a lot of
the stuff we're doing now, going back to the
animal models, we've got some really cool data
on how light is regulating the fundamental mechanisms
regulating sleep. So there's some cool stuff
that we're hopefully going to be publishing fairly
shortly. So, yeah. And now, of course, I mean,
you know, the past 10 years in particular, meetings
are designed where both circadian and sleep are
considered in the same meeting and the researchers
mix. And I think that's been incredibly healthy
for the field. Well, you talked about schizophrenia,
so I'd love to unpack that first. The mental
health element of sleep deprivation. So when
we're talking about the horrendous mental ill
health, addiction, suicide epidemic that we have,
I think globally, but especially in the professions
listening, again, as I mentioned before, the
focus a lot of times is the trauma that we've
seen. Now, there's undoubtedly a correlation
between childhood trauma that... you know we
had before we ever put a uniform on which is
very very rarely discussed but in my profession
in in the fire service in america the average
work week is about 56 hours the 24 hour shifts
which i'm not opposed to because we are in a
building with beds and you know i think that's
that's better than splitting it up into 12s and
rotating it but they only they get 24 hours on
and 48 hours off um so really that's a day between
24 hours without sleep um so With that initial
kind of thought process with the schizophrenia,
was it a kind of chicken and egg scenario where
the schizophrenia is making the sleep deprivation
worse and or the sleep deprivation is initiating
the schizophrenia? Yes and no. Really, what those
observations in schizophrenia made me think,
and of course our increasing understanding of
the mechanisms underpinning the neurobiology
of sleep, we produced a very straightforward
conceptual model. which is that because the sleep
-wake systems draw from all the brain neurotransmitter
systems and an interaction between multiple brain
structures, the hindbrain, the midbrain, the
hypothalamus, the cortex, there's immense complexity.
And we thought, well, hang on. Surely the pathways
and the networks that give rise to normal mental
health and the normal sleep -wake cycle overlap.
So if you have a mental health condition, let's
say an abnormality in a particular neurotransmitter
that predisposes you to a mental health condition,
it's going to have a parallel impact at some
level on the sleep -wake timing systems and the
sleep -wake systems in generally. The systems
overlap. We've got evidence for that because
genes that have been linked originally to mental
health problems have now been shown to be very
important in the regulation and the generation
of the sleep -wake cycle and vice versa. So we've
got empirical evidence for that. So there is,
and we kind of know this, a genetic predisposition
to have a mental health problem. And in parallel
with that, it will generate a sleep problem at
some level. Going to your point about the feedback
loops, of course, because of the destabilizing
effect of sleep and circadian rhythm disruption
on physiological and behavioral and indeed mental
health, that's going to exacerbate the mental
health status and the mental health status, of
course, and perhaps the drugs associated with
mental health to treat it. are going to feedback
and impact upon the sleep -wake disruption. So
you can go from something at the core, which
is a genetic predisposition of vulnerability,
and move very rapidly to a critical state because
you get that feedback loop where the sleep exaggerates
the mental health and the mental health exaggerates
the sleep. So if you follow that logic, you can
say, OK, well, perhaps we can think about the
sleep -wake system as being a therapeutic target.
And so what we did, and Dan Freeman, a great
colleague in psychiatry, led this study, we basically
were able to use approaches which would stabilise
sleep wake in individuals who had insomnia, but
also had paranoia and hallucinatory experiences.
And it was so phenomenal because just by stabilizing,
partially stabilizing sleep wake, you actually
reduced the severity, halved the levels of paranoia
and hallucinatory experiences, showing really
for the first time, that we can think about sleep
as a therapeutic target for mental health conditions.
So that's how that casual conversation in the
elevator with a psychiatrist has gone. And now,
of course, as you rightly point out, James, sleep
-wake is regarded as an incredibly important
element in both the... regulation, but also the
prevention of mental health states. We now know,
for example, that a change in the pattern of
sleep is characteristic of either a first depressive
episode or a recurrent depression. We've also
shown that in kids who are vulnerable at high
risk of developing bipolar are already showing
a disturbed pattern of sleep -wake. prior to
any clinical diagnosis of bipolar. And so what
that opens up, of course, is you look at those
kids who are vulnerable. If you stabilize sleep
-wake in those individuals, then will you divert
the brain into a different developmental pattern,
avoiding, let's say, some of the problems of
bipolar, or will you delay the onset of some
of these conditions? Now, we don't know the answer
to that, but what's now been appreciated is that
intimate association between mental health and
sleep. Well, my observations with multiple departments
I've worked for in the East and the West Coast,
I got to see different agencies, different shift
patterns, but roughly the same work week if you
break it down. seen with my own eyes more so
once i left the fire service because when you're
in it you your observational skills are not so
good because you're so damn tired yourself but
i've watched young firefighters deteriorate rapidly
like where i where i coach and train now there's
a few firefighters that began when i was there
and now we're you know five plus years into their
career so talk to me about the impact of sleep
deprivation on on the brain what is it supposed
to be doing at night and what is not happening
with our doctors nurses police fire etc yeah
i guess we can we can unpack this at two levels
i mean first of all what do we know about what
goes on in the brain whilst we sleep and we know
that memory consolidation is critically important
we know that it's not just the not just the laying
down of facts in our brain, but also we're playing
with information. So if you want to come up with
innovative solutions to complex problems, a night
of sleep has been shown overwhelmingly to be
able to help you make important decisions and
solve problems. So higher brain function is going
on whilst we sleep. In fact, some areas of the
brain are more active when we're asleep than
when we're awake. We also know some important
stuff that, for example, clearance of toxins
such as misfolded proteins, such as beta amyloid,
which, of course, has been associated with Alzheimer's
disease. That's being packaged up and got rid
of whilst we're asleep. And in fact, if you deprive
people of sleep and then look for beta amyloid
deposition within the brain, you can detect it
after just one night of no sleep, which may be
the mechanism. which accounts for the fact that
if you have poor sleep in your middle years,
it is a risk factor for dementia and Alzheimer's
when you're older. Now, I would never say that
poor sleep is going to cause Alzheimer's, but
if you're vulnerable, then this could be an additional
risk factor. So that's the sort of thing that
we see. as being critically important whilst
we sleep. But if you look at it in slightly different
ways, what happens to you when you don't get
sleep, and you suffer sleep and circadian rhythm
disruption, and emotional and cognitive responses,
you name it, it gets screwed up. So fluctuations
in mood, negative salience, what that means is
that the tired brain remembers negative experiences,
but forgets positive ones. So one's whole decision
making capability is based upon the negative
stuff that you experience, not the positive stuff.
I think that's such an important observation.
Irritability, anxiety, loss of empathy and frustration,
risk -taking and impulsivity. I think this is
really interesting. You do stupid and unreflective
things. So you're going, you think, oh yeah,
I can make that, I can get through that stoplight
before it turns red. And of course, Under normal
circumstances, you wouldn't dream of it, but
you kind of do stupid things when you're tired.
There's a greater use of stimulants to try and
override this overwhelming sensation of sleepiness.
Of course, decreased cognitive performance. You
can't process information, poor memory, poor
concentration, poor communication skills. You
can't actually articulate what you want. You
can't find the right words to actually express
yourself appropriately. And reduced social connectivity.
You don't feel as though you're part of, you
know, your community and your family. And you
feel that it's sort of somewhat detached. And
bearing in mind, I mean, we can talk about this
later, but, you know, the divorce rate, and I'm
sure you've seen this, James. in certain areas
of night shift work is so much higher than in
day shift. In fact, there was a study from the
state which showed that night shift workers doing
the same job had a divorce rate which was six
times higher than the day shift. And that can
kick in under relatively short term. So switching
between night shift and day shift, tiredness,
circadian rhythm disruption, you're going to
see this. And of course, that's why we need to
know about it so that we can at least be sensitive
to the fact that we may be going down that route.
Longer term night shift work, sort of the chronic
impact on physiology and health, well of course
there's daytime sleepiness which you can get
for short term but this becomes a really sort
of chronic problem. Microsleeps, it's estimated
that there are at least 200 ,000 crashes every
year on the freeway as a result of microsleeps.
This uncontrollable falling asleep at the wheel.
I think the American Automobile Association says
it could be actually three times greater than
that. So it's 300 ,000. Difficult to know. These
are particularly bad, of course, because unlike
other crashes where you are at least awake to
stop yourself. crashing into the car in front
of you or the barrier, you've fallen asleep.
So there's no recovery. So they tend to be faster
and more damaging. Cardiovascular disease, altered
stress responses. You know, you've got the activating
sort of cortisol and adrenaline. And of course,
that's feeding back. It's lowering immunity.
making you more vulnerable to infection. And
it's probably increasing vulnerability to cancer.
Classic studies on night shift nurses, higher
rates of colorectal cancer, breast cancer, and
in airline pilots, long -haul airline pilots,
higher rates of prostate cancer, for example.
Big metabolic abnormalities, you know, such as
obesity, type 2 diabetes. And of course, as we've
already touched on, greater vulnerability to
depression and psychosis. So I think it's so
important to appreciate that. sort of shift work,
sleep and circadian rhythm disruption is so much
more than the irritation of feeling tired at
an inappropriate time. It has an impact upon
our entire global health, our ability to process
information, respond to other people, our whole
mood, but it also longer term impacts upon our
physiological health as well. It's a really serious
issue. I mean, World Health Organization now,
because of the links between cancer and night
shift work, have identified night shift work
as a probable carcinogen. You know, this is serious
stuff. But I think, so why aren't people more
sort of tuned into this? Why is it kind of dismissed?
And I think it's getting better. But those of
us who remember the 80s, you know, when it was
in its lowest point, I guess, where people will
come into work and say, yeah, I've done another
all nighter. You know, people pat him on the
back and say, oh, how cool. And I think we are
beginning to realize that those sorts of people
will be despised in the same way that we now
despise smokers as not only causing harm to themselves,
but potential harm to others. You know, secondary
smoke of secondary accidents. I mean, you know.
tired pilots. And there's some really interesting
studies. There was an India crash over a decade
ago where the plane was landing and the plane
hit the deck and most of the passengers and crew
were killed. And what happened is that the pilot
had simply had a microsleep, had fallen asleep.
in the middle of landing the plane, this overwhelming
sense of tiredness. And how do we know that?
Because he was killed. Well, we know that because
you could hear him snoring on the voice recorder
in the cockpit. So, you know, it's not only harm
to yourself, but those passengers were killed
as a result of that individual suffering sleep
and circadian rhythm disruption. So, yeah, I
can't emphasize how important it is. Well, I
mean, you've literally summed up everything that
this community itself is from. And I think that's
the problem is, you know, if we just look at
carcinogens in our gear, we miss the cancer,
you know, big piece of the cancer puzzle. If
we just look at trauma, we miss a big piece of
the mental health puzzle. When I hear, I think
Dr. John Cordell, I think it was, who's a retired
naval captain, I think I've got that right. He
cited the Exxon Valdez and I think it was Fukushima
and some of these massive, massive incidents
that we had were all related somewhat to sleep
deprivation. And you think about all the millions
of men and women that are behind an emergency
vehicle day in, day out. And I think of some
of the, what we call line of duty deaths, some
of the people that are killed whilst wearing
the uniform. They fall off the aerial, the giant
ladder that we have. They get lost in a burning
building. They crash an intersection and kill
a bunch of civilians as well. How many of those
were actually related to sleep deprivation? And
then the chronic impact. There's a kind of, I
guess, unsubstantiated but pretty well -accepted
figure that a lot of us die within five years
of retirement. And the sad thing in America is
the fire service. The day we leave the fire station
for the last time, we cease to be a statistic.
So all these retirees that are dropping dead
like flies, and I just lost one from Anaheim,
a young fire captain died last week, 56 years
old. They're not factoring into the science.
So again, there's this kind of turning a blind
eye to not only the acute impact of sleep deprivation,
but also the chronic impact. Well, I think it's
a good example where long -term follow -up. is
absolutely essential in this sector. And the
health and wellbeing of these individuals needs
to be tracked beyond retirement. And one thing
I think we need to clarify, though, is that frontline
staff, whether it's police, fire services, our
medical professions, they're needed on a 24 -7
basis. And in fact, society generally now runs
on a 24 -7 basis. And so we're not going to put
that genie back in its bottle. So the key thing
for me is you can't say you shouldn't do it.
What we've got to do is look for ways in which
these issues are mitigated. And so we know that
long -term night shift work is where things can
really build up. And so perhaps we should limit
night shift work. to five years and then rotate
people back on to only day shift. That's one
sort of thought. But if we think about the various
problems, so after extended periods of work,
there's a greater risk of having an accident
on the drive home. So there was a study on junior
doctors in the UK showing that 57 % had either
had a crash or a near miss on the drive home
after the night shift. So what should we provide
for those individuals? Well, in Western Australia,
for example, the junior doctors are sent home
in a taxi. But what we could do really easily
and at low cost is use an app on a smartphone
which detects head nod or movement of the car
and alerts somebody to the fact that they're
falling asleep while they're driving home. And
in fact, of course, high -end German cars now
have that technology built into them. But we
could provide that to, again, reduce the risk
of falling asleep at the wheel. loss of vigilance
and tiredness in the workplace, we can increase
the amount of light, which increases levels of
alertness. That's not probably particularly useful,
I think, for fire services, but other 24 -7 factory
workers, for example. I think a really, really
important area is poor physical and mental health.
We should be having higher frequency health checks
in this sector to identify these vulnerabilities
and problems before they become chronic and you
can't do anything about them. And I think there's
an immense duty of care here that people need
to recognize this increased vulnerability and
do something about it, check for it, screen for
it. We know if you catch cancer early, there's
hugely success rates in long -term survival.
But if you detect it late on, You know, there's
not an awful lot. And if it started to spread,
it's really bad. So high frequency health checks.
So knowing that night shift workers have high
levels of obesity, diabetes 2, metabolic abnormalities,
what kind of food do we make available to our
night shift workers? It's high fat. It's high
sugar. And of course, we're predisposed when
we're tired to want that kind of stuff. But there's
no alternative. So what you want is high protein.
easy to digest snacks throughout the night shift,
which are not going to send your metabolism and
waistline into meltdown. And to my knowledge,
I don't think anybody's doing that in the sector,
which is completely bizarre. It's low hanging
fruit. It's something we could easily do. The
failure to consequence, to appreciate the consequences
of shortened and disrupted sleep. And I think,
again, it's developing the educational materials
so people know that there's a danger and know
what they're getting into and to know what kind
of problems they might experience. And it's not
just for the individual. It's for the extended
family unit. So partners appreciate that. It's
not that this loved one has turned into a monster.
It's the fact that this is. basically an inevitable
consequence of driving your biology outside of
its normal range by doing night shift work. And
I think if people knew this, they'd be much more
understanding of some of the odd behaviours that
night shift workers display. So education, I
think, is so important, not only to the individual,
but to the extended family group and partners.
So anxiety over apps, for example, sleep apps,
most of them are completely useless. They're
good for telling you roughly when you went to
sleep and when you woke up and how many times
you woke up in the night. But when they start
telling you about, oh, you had really good restorative
sleep or, oh, you had a bad night's sleep, they
can't do this. They're not. They just can't work
effectively. None of them are endorsed by the
sleep federations. None of them are FDA approved.
And so don't take these things seriously. They
can actually generate increased anxiety. And
one other area is that we know there's a biological
underpinning of being a morning person and an
evening person and an intermediate person. And
that's called chronotype. And I don't understand
why we don't chronotype our workforce to make
sure that the late types are best suited for
the late shifts. The morning types are best suited
for the morning shifts. And what you want to
avoid at all costs is a late person, a late chronotype,
working on the early shift. Because then there's
the greatest sort of what's called social jet
lag, the difference between your biological preferred
sleep -wake patterns and what's being imposed
upon you as a result of job or societal needs.
So I think it's not all hand -wringing. We're
not going to completely get rid of the problems.
But I do think there are low hanging fruit that
we could adopt now on the basis of the knowledge
we have now to just mitigate some of these problems.
So we're not stacking it up for even worse long
term problems. Yeah, and I agree with everything
that you said. And it's sad because. The conversation,
for example, with the fitness is a lot of times
put on the responder's shoulders where you need
to work out more. And I agree, you do. There's
an element of ownership in what we do, what we
sign up for. But that's kind of hypocrisy if
you're not creating an environment that allows
them mentally and physically to have the motivation
and focus and energy levels to walk into a gym
and take your health seriously. Yeah. And I think
the problem is that the employers kind of know
about this. But most of them, the business sector
is becoming much more sensitive to it, incidentally.
But most of them are just sort of sticking their
head in the sand. And my real concern is that
there's going to be a series of class action
suits where the whole thing becomes litigious
and reasonable dialogue between employers and
employees to try and get a better solution is
going to be. cast into the out of darkness. I
mean, you know, an employer could easily go and
say, well, hang on, you know, we know this stuff.
There are books published on this stuff. Why
have you chosen to ignore it? And so I think
we've got to move quickly before it turns ugly
and that we then are not being in a position
where we can do something constructive now. So
one of the problems I face, one of the doors
that I'm breaking my foot on constantly is in
America specifically, the bare minimum work week
is 48, 56 hours. So basically, like I said, 24
hours straight, no sleep. And I mean, genuinely,
a lot of these departments are either awake or
are getting terrible quality sleep because you're
waiting to be woken up. And then 24 hours off.
So basically, that first day you go home, you've
already worked eight of that. that 24 then you
go home and then the next day you're actually
ramping up to go back again so my there's there's
departments up in the northeast and there's a
couple around the u .s that do 24 72 so there's
another 24 hour period between shifts from speaking
to people that have done both you know they they
report you know it's a much better system to
me i love the phrase don't wait for Don't wait
for science to prove what you already know. So
people will come to me and say, oh, but can you
show me studies on how this 56 -hour week is
worse than this 42 -hour week? And I'm like,
really? Did you just ask me that? Firstly, the
sleep medicine world has all kinds of books,
including yours. But secondly, look, I mean,
you have Alison Brager and Rachel Mockwald and
all these military people that have come on talking
about the same thing. So with that being said.
If in this particular system, and we're talking
about bare minimum, a lot of these men and women
are then told at 7 a .m., you can't go home.
We need you to stay another 24 because we're
short staffed. So now you're getting into 80
plus hour weeks. My California department, just
to prove from what I've been told, 168 hour work
week if needed, which is, I mean, absolute insanity.
And this is, of course, throughout the sector.
I mean, you know, during COVID, frontline staff,
in the hospitals were often expected to do that.
And in fact, in the UK at the moment, we're chronically
short of hospital staff because so many are off
sick with either mental health problems or COVID
or something else. And that just then throws
greater pressure onto the people who are at work.
And I think, you see, Frontline staff like yourself
are good citizens. They do the job largely because
they want to help. They want to make a difference.
And so when asked to plug a gap, they always
will. That's true for the police. It's true for
nursing staff, for doctors across the sector.
And the employers know that you're going to do
that. And I think they need to say, look, this
is not right. It needs to come from the employers,
not the employees, because then you're guilt
tripped if you say no. They need to recognise
what they're inflicting on their staff and say,
actually, this is not acceptable. We have to
find an alternative. And whether it's, you know,
having a pool of backup people that you call
upon. But it is entirely unreasonable to expect
somebody who's already chronically tired to then.
carry on and endanger both their lives and other
people. So again, I think it's a dialogue between
employers and employees about finding these solutions
without making it worse. And of course, currently,
it's making the situation worse. And it relies
on the goodwill of people like yourself, who
will, of course, say, yeah, okay, this is really...
crap but you know i've got to do it because i
need it um and in and in fact there's got to
be an alternative um and um again it's got to
emerge from discussion uh from employers and
employees well one thing that's come up and again
there isn't the the research as far as actual
numbers but again it's perfect common sense because
as you touched on before sleep deprivation affects
us in every way so at As you progress through
a career, an employer has to spend a huge amount
of money on everywhere from wrongful injury lawsuits
to workman's comp claims, medical retirement,
land of duty deaths. And so therefore, the money
that's already being spent. it wouldn't take
all of that to reinvest into higher staffing
and therefore save that employer money as well.
So in your opinion, if more time was put between
these shifts, knowing that we have to have someone
to protect our streets every night, if we gave
them more rest and recovery between each shift,
what impact would that have on physiological
and mental health? It would improve both physiological
and mental health, reduce the accidents, and
therefore the collateral damage inflicting upon
perfectly innocent bystanders. And so, yeah,
I mean, one of the reasons I moved from Imperial
to Oxford 16, 17 years ago was the opportunity
of setting up this institute, the Sleep and Cicadian
Neuroscience Institute. And we have four strategic
aims. One is to understand the fundamental biology.
of sleep generation, sleep circadian generation
and its regulation. Two is to understand how
these systems fail as a result of societal pressures,
such as night shift work or disease, such as
mental health, or indeed other sorts of diseases,
neurodevelopmental diseases. The third is to
develop evidence -based and condition specific
interventions to try and mitigate some of these
problems that we've been talking about. And then
the fourth is to develop resources that educate
the broader community about what's going on.
And one of the great problems is that people
don't know about this stuff. In a five -year
medical training, most medics will have no lectures
at all, or maybe one or two, on sleep, on circadian
rhythms. And if they do have something on sleep,
it'll be about electroencephalography and how
it changes when you have schizophrenia or whatever.
And so what we've set up is a whole bunch of
educational tools, one of which is the first
fully online master's degree and diploma in sleep
medicine. So we've now got over 200 people all
over the world, health care professionals taking
this. And we organize tutorials at sort of the
time zone, appropriate time. And there's an opportunity
to come to Oxford and to take part in a summer
school. And I think what we've got to do is get
the information out there because there's this
sort of. I mean, most of society doesn't appreciate
the value of sleep. It's a luxury, an indulgence.
And actually, it's such a fundamental part of
our biology. We've just thrown it away without
appreciating the consequences. And so the excitement
for me in the last gasp of my career is to have
established this institute and working with the
next generation coming through on all of these
areas, fundamental science. all the way through
to its application, the development of new interventions,
and critically the educational component whereby
we can get this information across to the various
sectors. And hopefully we can start to engage
government in this regard. So there's, again,
authoritative websites with the best science
explained in the... in the simplest and most
adjustable way. We're not there yet, but that's
sort of the next door that I'm kicking at. I
might have to look into that myself, actually.
I got my bachelor's in exercise physiology, so
I might have to even explore the long list of
students. Yeah, that would be great. Brilliant.
All right. Well, then another area, it's been
interesting. I was first exposed really to the
sleep medicine world by Dr. Kirk Parsley. I don't
know if you've ever heard that name. He was a
Navy SEAL. Yes. We've never met. And so, again,
I'm sure what he was taught and believed back
then has again had a genesis to now. So I'd love
to kind of fact check a little bit. But one of
the interesting things that he talked about was.
tbi which again a lot of people listening military
law enforcement myself i've been a combat athlete
for quite a long time we have that tbi element
which from what i understand one portion is demyelination
of the the sheath and then you have from what
i would understand sleep deprivation which also
causes the same kind of thing is that still correct
with your understanding today and if so yeah
there's a compounding element between the two
it's it's very interesting traumatic brain injury
is of course something that i sort of come across
because of my involvement with Blind Veterans
UK. And in fact, their collaboration with Blind
Veterans USA. And it's one of the most common
features that occur, I mean, disrupted sleep
and circadian rhythms after traumatic brain injury.
And it kind of makes sense because what you're
doing is... is insulting the brain you're changing
the pattern of neurotransmitter release at some
level and that's almost certainly going to impact
upon sleep at some level so it's not dissimilar
to the sort of mental health state where you've
got these overlapping circuits if you screw one
up which predisposes you to mental health issues
it's going to predisposure to sleep and circadian
disruption, and any other insult to the brain.
So traumatic brain injury is clearly an area.
Another one, of course, is neurodevelopmental
problems in children, which are completely disastrous
to family life because the child often doesn't
sleep at night or will wake very frequently,
disrupting the sleep of the entire family unit.
So yeah, you know, it's interesting that one
could perhaps argue that good sleep, and of course
good sleep could be defined in a variety of ways,
and of course it's very variable between individuals,
but let's just, you know, use the term good sleep,
could be used as a metric for overall brain health.
And so, yeah, TBI, I think, is a serious issue.
And currently, we don't have a lot that we can
do. I mean, what the knee jerk reflects for all
of these things is, well, sedatives. That's tricky.
One, they don't provide a biological mimic of
sleep. They sedate the brain. And so some of
the valuable things going on are actually. are
lost. So memory consolidation, the processing
of information by dead drugs or whatever. Same
with alcohol. If people self -medicate, alcohol
is a sedative. These things are really very bad.
Short -term use, of course, of sedatives is okay,
but it's where you become completely dependent
upon them. You know, I think for TBI, what we
sort of recommend is that you just try and use
good sleep education, good sleep hygiene, which
is what's detailed in Lifetime, my book, and
of course, other books as well. And it's sort
of getting that, you know, during the day, you
know, getting sufficient light exposure, you're
exercising appropriately, you're not napping.
too close to bedtime. You're trying to transition
from wake to sleep in a sensible way. Meditation,
mindfulness can be useful for some. Yoga, exercise
for others. You are not using electronic devices
immediately before you go to bed because of the
alerting effect. It's all those sorts of things
that you can do to support. your biology that
promotes sleep and circadian rhythm health well
i think that's another very unethical thing that
a lot of those sleep aids have been titled sleep
aids i mean i think again kirk talked about there's
a correlation with premature death through sleep
deprivation and through ambient addiction, if
I got that right. And so, you know, these people
are thinking they're getting sleep and they're
not. And I know the absolute crutch in a lot
of our professions when it comes to a perception
of deregulation is alcohol. So you take a sleep
deprived responder, then they go home and have
a few beers, even if they're not, you know, quote
unquote, an alcoholic. Now you're destroying
their sleep that night and then the following
night and now they're back into it. So they think
they're missing missing good sleep one every
three days and they may be missing every single
night. Exactly. And I think that that that's
such an important point. And again, it's all
part of the sleep education. You know, really,
it's really it's. But as you know, because you've
been at the front line, it's really difficult
to get people on board. I mean, you know, after
a hellish time and you need to relax and wind
down, the easiest thing for most of us to do.
And I I'm the same, you know, is to have a whiskey
or a beer or something to wind you down now.
A small whiskey or a beer is fine, but it's where
you're using it actively as a sedative. I mean,
I actually spoke to somebody the other day, and
of course, Phenagon is one of these antihistamines
that passes the blood -brain barrier and can
cause incredible sleepiness. And stuff you can
buy over the counter because it's basically just
an antihistamine. And people are self -medicating
on things like that. And that can be a real insult.
I thought I'd try it one day just to see, you
know, as you do. And I thought, you know, there's
all this talk about ferrigan. And I took it on
a Friday evening and I was wiped out the next
day. I mean, it really had. And that's one of
the problems of these sedatives, because not
only do they not provide a biological mimic for
sleep, but they generate daytime sleepiness.
And so that's why they're never. prescribed or
they should never be prescribed for the elderly
or indeed individuals with dementia because it
kind of makes it worse so i want to hit on one
more topic before we go to jet lag and then kind
of round this up but um another thing that i
see in my profession um it's kind of a double
-edged sword in the men young men like you know
in their 30s a few years into their career i'm
seeing an absolute epidemic now of uh use of
exogenous testosterone and when when we hear
about the you know the levels that these men
are reporting from their annual physicals they're
absolutely in the toilet I don't know if there's
a direct correlation or indirect correlation,
but I'm also seeing what appears to be an inability
to conceive as well, far reduced fertility levels.
So I'd love to hear your thoughts on those. Well,
yeah, I mean, absolutely. Not only will testosterone
change sort of behavior, make individuals more
aggressive. There's good evidence for that. But
also high levels of testosterone will reduce
fertility. So there's that's that's that's a
yeah. I mean. What's also interesting, if we
think about women, I know there aren't that many
women in the fire service, but I mean, women
doing shift work generally because of the importance
of the circadian system in the regulation of
the menstrual cycle. And it's at every level.
It's the hormone release at the level of the
hypothalamus. It's the pituitary release of the
hormones that regulate the ovary, that regulate
the sort of the receptors that respond. I mean,
every level. you have the role of a circadian
clock and shift work has been associated with
reduced levels of fertility and higher rates
of spontaneous abortion. So, yeah, it's certainly
taking the exogenous testosterone in men would
reduce fertility, actually might even cause testis
to reduce in size. And in women. even without
taking exogenous hormones, the menstrual cycle
can be profoundly disrupted by night shift work.
Well, thank you for that. Because I think these
are things that we never hear that I think are
very important. Because the understanding that
improved sleep could elevate that testosterone
again is not on anyone's lips. And sadly, there's
an entire industry at the moment praying. on
tired people and telling them that this exogenous
testosterone is a magic pill and then ultimately
you're it's another band -aid it's not actually
addressing the root cause absolutely no i would
i would strongly advise and of course and of
course you can get testosterone i guess just
just online um but if you were to talk to your
general practitioner they would overwhelmingly
strongly um urge you not to do it because it
does have you know serious side effects So I
want to get to the round the world thing that
I'm about to do and get your perspective on that.
But before we do, circling around to the Blind
Veterans UK, talk to me about, because I'd never
really thought about this, you have some blindness
where the eye is still intact and some blindness
where through trauma the eye has been destroyed.
So talk to me about the circadian rhythm disruptions
that some of our veterans receive through their
service and then the chronopharmacology that
potentially could help some of these men and
women. So because of the discovery of this other
photoreceptor system within the eye, it's now
become clear that the eye is both the organ of
space because of vision, but it's also the organ
of time because of its regulation of the internal
biological clock. And what we discovered in mice
and then in humans is that if you've got genetic
diseases which have wiped out the visual cells,
the rods and the cones, you can still regulate
your clock. weird photoreceptors, the photosensitive
retinal ganglion cells are still there and working.
So one really important issue is that clinical
ophthalmologists now need to make sure that they're
giving the appropriate advice to those visually
blind individuals. There has been a tendency,
well, if you're visually blind, well, the eyes
are no use to you. But actually, circadian regulation
could be preserved so they need to look at that
and indeed people with no vision should be still
encouraged to get out if it's not going to cause
any further eye damage get sufficient light to
regulate their clock because otherwise they have
this double whammy which is of course vision
blindness which is bad enough But to have also
lost the ability to regulate your clock, as you
have if you've lost your eyes completely as a
result of trauma or indeed disease, then what
you get is that the clock keeps on ticking. But
for most humans, the clock is slightly longer
than 24 hours. So without eyes. we'll get up
and go to bed a little bit later and later and
later and later. So you rapidly become completely
desynchronized with the natural light -dark cycle
and indeed what your friends, family, and colleagues
are doing. And some of the discussions I've had
with individuals with eye loss have been deeply
moving. I mean, I remember, because these are
really fantastic individuals, they're very independent,
fiercely independent. And one chap was saying,
that he's completely tricked by his body and
he finds it so irritating. And he was telling
me of the fact that he knows that the next day
is a Wednesday and that's the day that he cuts
the lawn. So he wakes up, has worked out a way
to go outside, get to the shed, get the lawnmower
out, work out a way to cut the lawn. I mean,
you know, ferociously independent, brilliant
individuals. And then... he realizes because
the neighbors complain that it's three o 'clock
in the morning and it's that you know no sense
of time and and and a chat to and in fact i've
got some some nice quotes from those individuals
in the book um and one one was saying i'm slowly
becoming more and more isolated it feels like
constant jet lag and so this is a this is a really
profound issue so So why we're collaborating
is that because of our interest in how light
regulates the internal clock, we've sort of found
new receptors. We've now discovered the molecular
and signaling pathways whereby those receptors
interact with the molecular clock. And we've
got one drug, we've got four in development,
but one is quite advanced and is actually just
completing its first in human trials now. And
that will look at its toxicity and dose strength.
And then we'll work on healthy humans. And then
we'll work on individuals with complete blindness.
So we've worked it all out before we get to our
blind individuals. And the point there will be
you can take this drug. the clock will be fooled
that it's seen light. And therefore you can stabilize
the sleep weight pattern. And so if I can end
my career. by giving back a sense of biological
time to those individuals, I'll finish very,
very happy because it's such a debilitating and
appalling. We all know what jet lag is like,
but just imagine having it constantly for the
rest of your life and the social isolation it
causes, the fact that it's bad enough to try
and maintain a job if you have no vision. But
trying to maintain a job when you have no vision
and you have no sense of biological time is insurmountable.
So no, they're extraordinary individuals. And
I'm actually, because of the preclinical data
we've got, I'm confident we can do it. I mean,
we know what the pathway is. We know what the
pathway light activates. And we know that this
drug activates the same pathway. So I'm 95 %
sure we'll nail it, which will be, as I say,
fantastic. That's amazing. It seems like when
we think about veterans, and I've had a lot of
people on here, I'm actually about to get a gentleman
who's blind. He's not a veteran, but he's blind.
He's actually a downhill mountain bike racer,
and he uses some sort of sonar. I haven't spoken
to him yet, but it's pretty incredible, so I'm
looking forward to that. But we don't think so
much of our veterans that lost their vision,
that they're not as sexy as someone with a couple
of prostheses on. The challenges mentally for
losing your vision, as you said, losing that
interaction, adding the mental health impacts
of the trauma itself, of the TBI, and then you
take that circadian rhythm disruption as well.
I mean, most of us couldn't even think about
it. Yes, so no wonder the health in this particular
sector, you know, levels of depression, very
high, coronary heart disease, diabetes to obesity,
all the things that you see at a higher frequency
in this sector, which are dismissed as, oh, well,
that's kind of because they... can't see the
world, not because of circadian rhythm disruption.
Same incidentally in mental health. I mean, the
life expectancy of individuals with severe mental
illness is very much shortened, up to 25 years
in some cases. And what do they have? Coronary
heart disease, you know, cancer. all of those
sorts of features. And it's recognized, but it's
never considered as the product of the sleep
and circadian rhythm disruption. It's just either,
well, that's kind of what you get on these medications,
or this is what you have to endure. And of course,
you don't. You can stabilize sleep -wake in these
conditions, at least partially using cognitive
behavioral therapy and mitigate some of these
terrible health issues. It's amazing. Well, speaking
of veterans, I am about to embark on a journey
with a Navy SEAL friend of mine. He and some
other special operations men, and then there's
a couple of high -level triathletes, are part
of a year -long longitudinal study. There's a
ramp up where they're looking at different supplementation,
training styles, breathing techniques, mental
health elements. But the pinnacle event is called
7X. And in February, they're going to be doing
seven skydives, seven marathons, seven swims
in seven continents in seven days. So we're basically
going to land. They're going to do their thing.
I'm going to be kind of documenting it and being
support. Then we're going to jump in a plane,
go to another time zone, do the same thing again.
So with us circumnavigating the globe, from a
jet lag perspective, what would be some of the
tools that you advise? that group of insane individuals
to include in their toolbox? The first point,
in fact, one of the big papers we published a
few years ago actually explains how we get jet
lag. We've actually identified a protein. So
when you travel across to a new light -dark cycle,
a new time zone, why does it take a day for every
time zone you've crossed to adapt? Why don't
we adapt immediately? And we discovered that
this protein is turned on and actually... turns
the light input pathway off. And so it limits,
it acts as a brake on the effects of light on
the clock. So that's not particularly helpful.
Actually, it was quite interesting. When I met
Prince William a few years ago, he had obviously
been briefed. And it was quite funny because
he said to me, he said, what do I do about jet
lag? And I said, well, the good news, sir, is
that We understand the fundamental mechanisms
of jet lag, and we can cure it in a mouse. The
problem is we can't quite do it yet in humans.
It's a roar of laughter. And it's true. I mean,
I think that we will be able to do it because
actually, if we can get an inhibitor to that
protein, we'll take the brake off the effects
of light on the clock, and then you'll be able
to adapt. And that's what we've done with mice.
And so what can we do now, which is the key thing?
Well, the first point to really emphasize is
it takes a day for every time zone you've crossed
to adapt. So if it's seven time zones, it's seven
days at least. And some people a little bit shorter,
some people a little bit faster. Melatonin will
have a very mild effect. So don't rely on melatonin.
It's often missed. completely inappropriately
called a sleep hormone. It is not a sleep hormone.
It's a very mild modulator. And there's a lot
of nonsense talked about melatonin, sadly, and
a lot of misinformation out there. So, okay,
what can we do now? Rule of thumb is quite straightforward.
If we're traveling west, then you seek out the
light in the new time zone. And that will mean
you'll adapt faster. If you're... traveling east
it's a bit more complicated if you're traveling
more than six time zones avoid morning light
for the first few days in the time zone that
you're going to dark glasses or whatever and
seek out afternoon late afternoon light i won't
go into the reasons why but it's based on solid
science and so really traveling east is much
more of a problem for most of us And part of
the problem is that we tend to hit the clock
at the wrong time in the new time zone, which
instead of dragging us forward, it can actually
push us back. So when we see light is actually
rather important. But that rule of thumb, traveling
west, seek light out, traveling east more than
six time zones, then it's avoid morning light
and seek out afternoon, late afternoon light.
And that will help you adapt better. And that's
what I do. However, I'm just amazed at what you
guys are going to be doing. I mean, I find it
difficult not to get out of bed in the morning,
let alone jump from planes and, you know, do
it all of that stuff. It's extraordinary. You're
crazy. Yeah, well, they're doing it. Like I said,
I'm supporting, but it is an interesting thing
because if you think about it, as you've got
that progressive sleep deprivation and they're
doing, some of them are base jumpings. They're
jumping off a building. Yeah. And I think actually
on a serious note is that they need to know.
I mean, the problem, we sort of touched on this
earlier, but I think it's worth emphasizing it.
The tired brain is so tired it can't detect how
tired it is. And so it does stupid unreflective
things thinking it's OK. So you need to tell
these guys that actually you really need to assess
the dangers and the problems and the potential
risks. Seriously, because you're going to be
more impulsive. You're going to be less sort
of reflective. And so, for goodness sake, think
about this as they get more and more tired. And
their reflexes will also change. Also, if they're
spending a lot of time with each other, they're
going to start to find each other irritable.
Oh, yeah, I can see that, too. Suck on a plane
for seven days straight. just it's yeah nightmare
now the whole point of this though at the end
of it there's going to be a reboot phase and
they're writing a manual for military and first
responders on you know, a lot of the science
that works. The pinnacle event, of course, is
a pseudo -shiny object. The whole foundation
of this is a fundraiser for their non -profits
for burn -injured and mental health issues in
the first responder and military professions.
So there's an altruistic, you know, reason for
it. No, I think that's wonderful. But do, you
know, it's not without some danger, obviously.
And they just need to be, again, it's that educational
piece. Just, you know, their metabolism, their
diet, they're going to get hungry at weird times.
You know, they're just going to, they might again,
as we've touched on, say, oh, you know, maybe
I'll just have not just one whiskey tonight,
but I'll have just a few. And because you become
just, you slide into a strange metabolic space.
And so, yeah, just warn them. Beautiful. Well,
thank you. So your book Lifetime, which I was
lucky enough. It's funny. My dad sent me a copy
and it went to my old house. He didn't put my
new address. So the first one got sent back.
So I got the second one. But absolutely incredible.
And the fact that you do focus on shift work
and some of these areas that, you know, some
of the other sleep books that are well known
don't really explore. a lot of the communities
that are listening at the moment. So I was actually
blown away by, I think it should be another Bible
for wellness for everyone, especially if you're
a shift worker though. So tell me about what
made you write the book and then where people
can find it. There were two motivations. One
is as an academic working in this space, largely
paid by public funds. I think it's an absolute
duty. to get this information out to the broader
community. It's no good just talking to other
academics and other people in the know. We have
an absolute duty to disseminate this knowledge.
And there aren't that many really good ways you
can do it. You can do the occasional radio interview,
but you just need to get all the information
out there. And so it was that that was the primary
motivation. And one of the things that I was
really... pleased about is working with the editors
at Penguin was that first of all it's fairly
light in the sense that it hopefully most of
it is fairly easy to read and it was interesting
because I would I put in like a little story
a little anecdote and they said oh this is great
you know put more of those in because that's
great it makes it easier to read and as an academic
You tend to shy away, you know, you don't do
anecdote, you don't do little stories, but I
now appreciate that it can make the stuff more
digestible. I was also thrilled because they
didn't kick back at all that there are 921 references,
you know, a significant number of millimetres
of the book is references. And they're very light
touch, there's just a small little number. where
the science is quoted. And the logic behind that
has been that people can go to the original papers
or the reviews and they can get more information
in the topics that they want to explore. I mean,
a good example of that was a lady wrote to me
saying, I was really amazed that if you take
your antihypertensives before you go to sleep
rather than first thing in the morning, it can
halve your chances of a stroke and a heart attack
over a 10 year period. I mean, this is phenomenal.
And the data are based upon thousands of individuals.
You know, it's solid data. And she said, I mentioned
this to my husband. He said, oh, don't be so
daft. You know, it doesn't matter when you take
them. She said, well, why don't you just go to
the reference and check up? the paper. And he
did. And he said, my God, you're right. And so
I think it's respecting the reader and empowering
the reader with this kind of new science. So
that was the first motivation. The second is
I was getting increasingly irritated with the
sort of sergeant majors of sleep screaming, you
must get eight hours of sleep. You must do this.
You shouldn't do that. And it missed the whole
point about. human diversity sleep is a very
tight dynamic part of our biology and like like
shoe size one size does not fit all so in the
healthy range of sleep it can be six hours to
10 or 11 hours and one chat came up to me before
lockdown and said i don't get eight hours of
sleep am i going to die and i said well i can
tell you for sure you will die uh but it's not
necessarily because you're not getting eight
hours of sleep and it's that kind of we've become
more aware of the importance of sleep at some
level but it's then made us anxious about it
and and i think that's been deeply harmful because
when we get anxious about something we just run
in the opposite direction we don't take it on
board um and so um i i hope that I could emphasize
the fact that it's very variable. The sleep that
we get will change as we age, will change immensely
between individuals. The sleep duration, the
sleep timing, and all this stuff. And I think
that what we've got to do as individuals is work
out if we're getting the sleep that we need and
defend those behaviors. So it's not rocket science.
Do you feel as though you can cope optimally
during the day to do the job that you do? I mean,
do you feel able to cope? Are you dependent upon
an alarm clock or somebody else to get you out
of bed? Do you oversleep extensively on free
days? Do you feel sleepy, irritable, fatigued
when you are awake? Do you crave caffeinated
drinks? Do you find yourself doing... impulsive
and unreflective things and again listening to
your friends family and colleagues are you showing
irritability loss of empathy are you doing disinhibited
stupid and unreflective things and you know that's
it it's the kind of stuff that our grandparents
would have told us really it's very straightforward
and if we listen to ourselves we know whether
we're getting enough sleep or not we don't need
a wretched app or somebody screaming at us that
we've got to get eight hours or whatever. And
so that was the second motivation, which is to
make the science accessible, but also de -stress
this extremely important part of our behaviour.
Yeah, well, I'm glad you brought that up as well,
because I see a lot of people with the wearables.
And of course, there are some that have great
applications and they motivate a certain personality
type, definitely. Yeah, I chatted to a couple
of twins recently, two lads, and they've got
these devices. And, you know, they ring each
other every morning and say, oh, yes, how much
good thing did you get last night? They're competitive
about their sleep. I mean, yeah, it's just madness.
Yeah, it's interesting. There's a wonderful scientist
called Ken Wright, and he's at the University
of Colorado. And he has a big sleep class. He's
a university professor. And, you know, there's
a hundred, I don't know how many kids, but a
hundred kids in the class. And he asked them,
who here has ever had a sleep app of any sort?
And everybody raises their hand. And then he
says, OK, who now is using a sleep app regularly?
And about three people put their hand up. You
know, these are smart kids. They know that they're
being told nonsense half the time. And in a sense,
why would you trust? an electronic device that
has been validated in about 12 California high
school, you know, university students, when actually
the best metric of whether we've had a good night's
sleep is ourselves. Well, that was always weird.
I'm forgetting the name. I've got his book behind
me. But one of the men that wrote one of the
first sleep books in that, it was very interesting
because he talked about the actual metric was.
sleepiness was fatigue and so you know with it
you know we were so used to millimeters and milliliters
and you know all these these metrics that are
measurable but it you know it it's not complicated
as you said if you feel tired there's probably
a lack of sleep but actually you raise a good
point and i think we need to just disentangle
sleepiness and fatigue so sleepiness is cured
by sleep simple as that fatigue is lethargy an
overwhelming sense of tiredness, probably a depressed
mood. And fatigue can't be cured by having extra
sleep, usually. And it's an indication of an
underlying health issue. It's very interesting.
I spoke to a lady fairly recently, and she has
an immune problem. and she has terrible fatigue
she's she's determined she's very active wants
to do stuff but she just can't during the day
because she feels so fatigued and so what happens
is that she gets to sleep and then she wakes
up and then she's so anxious because of all the
stuff she's failed to do during the day as a
result of the fatigue and so fatigue and sleepiness
can obviously interact but if you're feeling
and you're sleeping, you know, sufficiently.
COVID, a classic example, you know, people slept
longer but still felt fatigued when they were
awake. And so if fatigue persists, I think you
need to see your general practitioner to make
sure that there's no underlying health issue.
So it's really important to separate sleepiness
and fatigue. Well, thank you for that. One thing
I meant to ask you, and I'm just going to squeeze
it in right at the end here. So I've been out
of the fire service now for four years. I would
say definitely still lent into alcohol till not
even a year ago. So really been a lot more diligent
now. pulled way way back on alcohol consumption
that's had a great impact on my caffeine consumption
um i meditate my my work output still seems to
be good um but the one thing i'm still struggling
to shake is brain fog so do you have any kind
of um advice for people that maybe seem to be
doing a lot of the right things but maybe missing
part of the puzzle when it comes to that particular
symptom yeah brain fog is is not fully understood
I mean, you know, in some sense, it's a symptom
of fatigue. And so fatigue can also be generated
as a result of excessive anxiety. And so I think
without digging down into the specifics and individual
details, it's difficult to know what the origins
of the brain fog might be. It may well be as
a result of, I mean, I don't know if you've had
COVID. It could be a long tail from that. A lot
of people now, it's being appreciated, a lot
of people are still suffering from a brain fog
as a result of long COVID. But there are other,
you know, an immune imbalance, a metabolic imbalance.
There's lots of other things that could be causing
brain fog. Some would argue, and I don't know
how good the data are. is even your gut bacteria
might be important for brain. I mean, who would
have thought it that, you know, the bacteria
in our gut can not only change our metabolic
status, but there's even evidence that in ways
we don't understand, they might even affect our
mood, depending upon the gut bacteria you have.
And so, you know, other things that people try
are biotics, you know, changing, you know, augmenting
their gut bacteria. But as I say, I don't know
how good those data are. It's not where I would
have, you know, have much expertise. Now, with
previous concussions and TBIs, would that be
also a potential contributor? Absolutely. Yeah,
yeah, yeah. I mean, you know, it's a big, you
know, traumatic brain injury is a huge insult.
And yeah, brain fog could easily be linked to
the fact that the brain has sort of adjusted.
It's kind of sometimes rewired itself, but it
might be slightly different to some of the wiring
you had before. And so, I mean, the brain is
remarkable. I mean, as people endlessly say,
the most complicated structure in the known universe.
I love that. Particularly when I talk to my astrophysic
friends, you know, who go on and on about the
wonders of the universe. Actually, the greatest
thing in the universe is sitting on top of our
head. But it's delicate. And so brain fog could
easily arise from traumatic brain injury. Beautiful.
Well, thank you. I spent a lot of time with gentlemen
that were trying to rearrange my face, so that
could be part of it. All right. Well, so for
people listening, I know that the American book
is out or is about to come out. So where can
people find that? Okay. So they can find it on
Amazon. Is that the best place? Yeah, I think
so. Yeah, it's I know it's advertised at the
moment. So it's, you know, let me let me just
make sure because the English version and the
American version have slightly different titles.
So the American title is Lifetime, Your Body
Clock, and its essential roles in good health
and sleep. And it's I think it's coming out 20th,
19th, 20th of or maybe towards the end of August.
Yeah. But you can pre -order now. Beautiful.
Yeah, it's funny. My sister is an editor. She
works for British television. And she texts me
and asks me, okay, this is what I want to say,
but how would I say this for this American audience
that I'm editing for? And it's fine. I mean,
your English title should have been fine for
the American title. It's interesting being an
expat, seeing the two differences, and sometimes
they have to kind of phrase it in a different
way to make it more catchy for one audience or
the other. And I haven't checked whether they've
changed the spellings, actually. Getting rid
of the U's? Behavior has got a U or not. I don't
know. I haven't checked. It's only just arrived.
Well, Russell, I just want to say thank you so
much. I mean, I'm so glad that, you know, my
dad... brought your work to my attention. And
I know he was enamored to hear that we were going
to have this conversation. I'm actually going
to put it out immediately because I think it's
so important what you've told us for the people
that are listening. But we went over. I truly
appreciate you being so generous with your time
and coming on the Behind the Shield podcast today.
It's been a lot of fun, James, and thank you
for inviting me. And please send my warmest wishes
to your dad. Tell him that if he can get to Oxford,
we should have a reunion and a cup of coffee
or maybe something stronger.