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I'll spell that to you because it's not as you
think, T -E -A -M -B -U -I -L -D -R .com. Welcome
to the Behind the Shield podcast. As always,
my name is James Geering and this week it is
my absolute honor to welcome on the show, researcher
and associate professor, Dr. Nicole Bowles. Now
in this conversation, we discuss a host of topics
from the firefighter shift schedule, the 1323,
the chronic and acute implications of sleep deprivation,
cannabis and sleep, stress mitigation, health
care, and so much more. Now, before we get to
this incredible conversation, as I say every
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 single
five -star rating truly does elevate this podcast,
therefore making it easier for others to find.
And this is a free library of over 1 ,100 episodes
now. 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 on planet
Earth who needs to hear them. So with that being
said, I introduce to you Dr. Nicole Bowles. Enjoy.
Well, Nicole, I want to start by saying two things.
Firstly, thank you to our mutual friend, Steve
Sakaguchi, for making this connection. And secondly,
I want to welcome you onto the Behind the Shield
podcast today. Thanks, James. Thanks for having
me. So where on planet Earth are we finding you
this morning? Oh, that's great. I'm in Portland,
Oregon, on the top of the hill where OHSU stands.
Beautiful. Well, I would love to start at the
very beginning of your timeline before we get
into what you're doing currently. So tell me
where you were born and tell me a little bit
about your family dynamic, what your parents
did, how many siblings. Oh, that's okay. We're
going way back. Way back. Yeah. So I'm originally
from Philadelphia, born and raised Chestnut Hill
specifically. And yeah, my parents were... young
when they had me um my mom worked at like a pharmacy
um and then she went she ended up going more
like an insurance um sales but um just like like
customer service level. And then later in her
life, went back and went to college and graduated
right as I started grad school, actually. And
then my father had multiple sclerosis. So he
was in and out. He had just recently got diagnosed
when I was born, but the symptoms were starting.
And so fatigue was heavy. And so he worked in
construction for a little bit. And then some
customer service, but ended up on disability.
And so for most of my years, I mostly just remember
him in a wheelchair and his health declined over
my life. And he ended up dying or passing away
when I was a senior in high school. And my mom
actually, she had type one diabetes, which was
diagnosed shortly after I was born. So just having
two autoimmune diseases and more broadly, my
my grandmother, my dad's mom's side of the family,
there's quite a lot of autoimmune diseases. So
a couple of people have lupus and some lesser
common conditions. And so that's what really
got me interested in doing research. So that
was my initial drive when I was thinking about.
what I wanted to major in um in college um and
then my parents got divorced when I was quite
young when I was two um and yeah so and so I
I spent most of my time with my mom and then
I would see my dad every other weekend who ended
up living with my grandmother because of his
um condition and so I was always really really
close to my grandmother who was um a or not college.
She was second grade. That's not right. Fourth
grade. Yeah. Fourth grade. She did some fifth
grade teaching in Kensington, Philadelphia. So
if anyone's aware of Kensington, I think it's
probably more popular now because of so many
videos that have show the drug use in that area,
but always a low income area. And so I would
always. go once or twice a year to help her set
up her classroom. And towards the end, because
my school always got out before her school did
and to spend a day or so I'm with her in the
teaching room. And so, yeah, I don't know. I
guess I'll just say, I just, I've had, I, uh,
I've seen, I've seen various, um, uh, I don't
know, circumstances from my, from my own to,
um, yeah, those were quite low. I remember she
one of the times because someone didn't come
to school towards the last day and I remember
her actually like walking over to that parent's
house and so I got to see what again like well
a lot of the videos are out there now it wasn't
nearly as bad back then but but still some pretty
impoverished areas in homes so Yeah, I don't
know. I guess those are the things that I'm thinking
of when I think about like my early childhood.
I ended up moving away from Philadelphia and
into the suburbs when I was fifth grade. And
I honestly think that like changed probably the
trajectory that I went into the schools, what's
available at those schools compared to the Philadelphia
schools. seeing the materials that my grandmother
had versus what i was able to get in the suburbs
and like having ap classes available to me having
i took photography in high school for two different
years there was like interior design classes
just the amount of things that were available
and the resources that were available i'm not
honestly sure if i would have went to college
if i hadn't moved to the suburbs and maybe had
some of those influences around me because It's,
I think, me and my one older cousin among my
dad's side of the family who were the only ones
who have still gone on to college. And then my
grandmother herself, who was also somebody who
went back to school after she had her four kids.
It's, again, similar to my mom. So, yeah, I don't
know. Those are the things I think about when
I think about my childhood. Interesting. There's
so many things I kind of want to just... unpack
for a moment firstly kensington i had a photographer
suzanne stein and we're talking about current
day kensington and the tranq epidemic that's
just just ravaging that community you have a
kind of interesting perspective though in the
conversations with your grandmother did she ever
talk about some of the systemic issues that were
creating such desperation in some of these communities
yeah it was like a circle of circumstances right
i mean i remember one time she told me she found
out one of her fourth graders was pregnant right
and so um i mean i can't imagine right being
nine and and then being you're becoming adult
essentially at nine or if you want to i don't
even know you're not an adult you're just a child
raising a child so there's just a lot of poverty
and it's how really it is hard to get out of
those circumstances and in some Often because
of the stress you have and you don't feel like
there's any other way you do turn to drugs. And
so, yeah, there's a circle of that. I do remember
some of her students who made it out and they
would run into her in the mall. We would see
somebody and just like how proud they were to
be able to tell her that they were able to make
it out. And, you know, the role that she played
in that she. As a teacher in that school, I remember
not only interacting with her students, but then
the other teachers and the principals. And they
could always give what was considered like the
troubled kids to her because she was always able
to like nurture them. And so and they they they
just acted different. Like she could just say
their name and they would they would stop whatever
they were doing in the recess. And it was because
they had like a respect for her, but also because
she didn't treat them differently. maybe even
gave them like extra attention and warmth and
um yeah so i remember those same kids like coming
up to me when they were in fourth grade saying
how much they like loved my grandmother and how
lucky i was um so maybe it was just like their
ability to have that that sheltered time that
protected time um like on the other side i remember
also there was one time where like um child child
protective services had to come to her classroom
because a kid had had like indications of like
being strangled. So yeah, I mean, there's just,
you know, abuse and those, the trauma that leaves,
unfortunately, if it's not dealt with, it comes
back up. And so there's just a circle of it and
it makes it really hard to get out of those circumstances.
I interviewed a Finnish educator who actually
moved to Australia. Now he tours the world talking
about the Finland education system. And I'll
never forget this. He talked about they invest
more in the schools that are more challenged,
whether it's poverty or whatever the barrier
is to those kids kind of being elevated. The
Finnish government invests more money in those
areas. And then you look at the way the American
system is, you know, if you're not performing
air quotes as a school, then you lose support,
you lose funding. So it's such a backward, you
know, philosophy and you've educated it perfectly.
Same exact person. You were in one environment
and you reflect back now and like, what have
I even gone to college? You simply moved to a
different postcode and the environment was completely
different. Exactly. Absolutely. Well, then also
with this autoimmune history that you have, we're
kind of jumping ahead. But in this research path
that you've got, have you found any common denominators
to some of the underlying causes of autoimmune
disease, especially in modern society? Yeah,
no. So that's originally when I was like applying
to grad schools. That was my intention to study
that. But at the time I was I was. thinking about
what program I wanted to go into, I was thinking
about like, what are the causes, right? I think
again about like my mother's upbringing and my
father's upbringing and my other relatives, like
what, what was it about their environment that,
you know, suddenly like we have so much. And
so part of it, I'm like, okay, there's, there's
likely a genetic, but it's not coming on everybody.
So what, what is it? And so I, that's how I got
interested in more like, I don't say I'm not
environmental researcher, but I study. exposure
to light and so that's how i got interested in
just like what are the impacts of our environment
on health and part but also stress like that's
as i was actually writing my applications and
really thinking about what i wanted to study
like stress just just continued to come up in
my mind like how people are able to perceive
the straps how they're able to cope with it and
how does that um translate to our health and
so I ended up going in that direction. So I never
came back around to autoimmune diseases, but
I do now study like those environmental exposures,
those stress exposures, and think about how they
are impacting stress or impacting health. And
who knows, like maybe one day I'll still come
back to the autoimmune side of it. My whole philosophy
is I go back to the fact that I truly believe
that the creation of the human being through
all these kind of survival of the fittest generations,
has an innate ability to heal has an innate ability
to thrive and of course we all know that there
are anomalies but in you know generally i think
that's the case so then if you look at that and
all these people that for example suffer immune
you know autoimmune disease yes there's a maybe
a genetic i want to use the word weakness that
sounds kind of um you know a judgmental word,
if you like, but, you know, a tendency maybe
to get some of these diseases over other people.
But what, you know, what are those factors? Because
I truly believe like, you know, for example,
not everyone is supposed to be obese. We know
the external factors, the sleep factors that
contribute to that. So, you know, once we can
really take a step back and start identifying
the contributing factors to these diseases, we
can at least have some power over them versus
if we just shrug our shoulders and say the word
genetic. I feel like we're missing a big part
of the puzzle then. Yes, I agree. As I was thinking
about that, my mom, so my mom was adopted and
she was like cleaning out. records that she had
from her mom like her adoptive mom she found
some records from the foster home that she was
in for a brief amount of time and back then I
guess there wasn't formula in my mind like formula
has been around for a long time but then yeah
so how do you then feed a newborn and so they
had like this regimen of mixing like I don't
I I can't remember exactly. I wanted to say milk,
but maybe they knew enough that they couldn't
give cows milk, but there was juice. They were
giving a baby juice. It was like, give this much
apple juice and give this much. And then it's
like, okay, are we maybe surprised she became
diabetic if she was just getting basically pure
sugar as a newborn? I mean, she was able to grow
and reach heightened milestones and whatnot,
but perhaps not then surprising that. later in
life, she wasn't able to process sugar. Absolutely.
I mean, for example, ALS, you know, there are
a lot of people that do combat sports and football
that don't get ALS, but it seems to be a common
denominator in the people that do is some sort
of head trauma. So again, just because everyone
doesn't get it doesn't mean that you ignore some
of the contributing factors. So what about the
research journey, then you kind of, you know,
you're looking into the stress world now, was
that immediately sleep medicine? Or did it kind
of start somewhere else? glucocorticoids, so,
you know, cortisol in humans, corticosterone
in rodents, and looking at mechanisms and how
that was impacting metabolism. And then towards
the end, looking at just natural ways to potentially
alter corticosterone. Again, I was working in
rodents. And that was through changing lighting
regimens. So instead of... we generally have
12 hours of light, 12 hours of dark, we would
manipulate that. So they had a 20 -hour day with
10 hours of light and 10 hours of dark. And that
drastically impacted their regular corticosterone
response. And so it was that, in part, that got
me more into sleep and circadian research. But
I was also interested in perceptions of stress,
as I just mentioned. Even while I was in grad
school, part of the reason I went to Rockefeller,
they have a very unique program where you can
basically pick the courses you want relevant
to the actual research you're doing. And so I
even at that time knew I wanted to pair like
basic science research with public health. And
so I took courses at Columbia's School of Public
Health and I went to University of Michigan and
took some of their courses. And again, I was
thinking like, okay, mice, I can't measure how
they're perceiving what we're doing. If we're
changing their lighting, if we're restraining
them, like I'm not capturing fully what I want
it to. And so I ended up going and getting a
degree in clinical epidemiology from Weill Cornell,
which is Cornell's medical college. And further.
going into my circadian research trying to translate
what i found in rodents into humans and also
just like learning how to run epidemiological
studies and qualitative studies so not just getting
um getting surveys or running blood panel tests
but actually meeting people where they were and
understanding um in a more just conversational
way what they're experiencing which has been
a great tool um that i've used um for ever since
then for research and engaging with different
populations um but yeah so what that's really
when i got into the sleep in circadian and i
worked with new york city transit workers and
um saw that again it's clearly it's not just
the hours that they're working right but it's
it was so many other factors look just like Based
on the hours they're working, what kind of food
is available to them, especially if they're a
conductor in a train and there's only certain
places they can go to the bathroom and where
they can eat. That dictates the choices and when
they're going to drink something to hydrate themselves
and the kind of foods that they're available.
Also, because there's not even a refrigerator.
So even if they bring food with them, how can
they keep it in safe conditions? also just opened
my eyes to that it's yes scheduling and things
like that are part of the issue but um it was
a much it's multi um level you mentioned the
rat study what were the findings what was the
impact on cortisol or the vat version of cortisol
with changing the uh the day their perceived
day yeah it flattened it out So there's some
research that shows that glucocorticoids are
important for connecting the clock in the brain,
the master clock, which is largely driven by
light response. And then cortisol is able to
connect that in the periphery. And we saw that
when you alter the lighting and they're not able
to entrain to the new day, their cortisol rhythm
is flattened. And then those animals end up gaining
like a metabolic syndrome. like phenotype. So
higher triglycerides, higher, I'm trying to remember
what we measured, but like a pre -diabetic state,
increased weight gain, things like that. Sounds
like the fire service. Interesting. Have you
come across the work of Professor Russell Foster?
Not by name. I might be aware of the work, but
I don't recall the name. It's really interesting
because he actually was the man who discovered
the chronoreceptor in the eye. So he's the neuroscientist,
went to the ophthalmology world, and they had
rods and cones. And he was like, look, there's
something else. And he was talking about the
chronobiology of this, the circadian rhythm.
And he was literally laughed out of many a hall,
many a conference talking about this. And he
was ultimately able to prove it. And so it's
really interesting because he is the pioneer
of this. And yet you never hear him discuss.
So I try and put his name out there. But phenomenal.
He's got a book called Lifetime. He's actually
he's been on the show. He's coming back on in
a few weeks again. But if you haven't looked
at his work, I mean, probably a lot of the work
that you're actually looking into originated
from from his lab in Oxford. But yeah, so then
so let's kind of move forward then. So you now
look trying to look at the human side. you're
working with the transit authority specifically
what was the next step as far as the impact of
these different shifts on the human now yeah
so i still wanted to because look at my basic
training i was still interested in more mechanisms
and studying just purely going straight into
the field i wasn't going to be able to answer
those questions either so i ended up coming to
that's when i came to portland to work with stephen
shea at the oregon institute of occupational
health sciences who runs human studies under
highly controlled conditions and so we can manipulate
just like i do for i did for the mice i can change
their lighting schedules and their day duration
and we can tease apart using math models what
are the contributions of the circadian system
versus what are the contributions of behaviors,
sleep, you know, eating or diet. And so, yeah,
so then, so they ended up coming out here to
do that. So what, what were some of the findings
that surprised you when you started diving into
that area, as far as the impact of the human
body on some of these shifts and changes in work
environments? So yeah, we can study the underlying
condition or the biology, which is important,
especially for drug development and things like
that. So it's nice to have that perspective when
then going into the field because we can... understand
like that's how we understand that there's the
two process model for sleep and you're you have
a circadian system that drives alertness and
then you have the sleep homeostatic process which
the longer you're awake the more tired you are
right so it's nice to have to be able to study
that and you can only do that under controlled
conditions what makes it hard in translation
is that you can give an ideal schedule but then
you meet real life and that's um you know having
social needs when you're off that's going to
prevent you from maybe sleeping at the ideal
time right we can come up with a schedule that
says if you're awoken this much while you're
on shift you can you need to get this much recovery
sleep in this amount of time which i should the
science not isn't necessarily there yet either
but let's say we could get there You also just
meet reality, right? And so that's been the great
thing about working in the field. But it's also
the biggest challenge because then you have multiple
levels that you have to develop interventions
for. And then you also have to learn how to implement
those interventions. And so that is where we
are now. And that is the challenge. I mean, then
you also have things like budget, right? Like
what are the budget requirements and the culture
of the particular... Think about firefighters,
the culture of the particular department, right?
That we have in Oregon, there's a lot of the
departments have individual sleeping quarters.
And so that is what the culture is there, right?
But I'll speak to somebody in a different part
of the world where it's like, well, not only
the chief should have individual sleeping rooms,
everyone else should be in a dorm room, right?
Regardless of the fact that maybe someone has
sleep apnea and is snoring and is keeping everybody
else awake, it doesn't matter because that's
what is expected in our department. So there's
just a lot more things that, okay, yeah, there
is the underlying science, but then you also
just have the actual, you have the psychology
of individuals and the sociology of the larger
group. With some of the sleep studies that have
been done, I'm thinking about an actual study
in a lab versus putting wearables on a firefighter,
for example. What does that kind of look like
as far as a landscape? Are they usually students
of that college? Who's running the projects?
No, that would be the actual recipients. Of the
outcomes of an in -lab study? Yes. Let me put
it. in a better way. So, so the people that you
are going to study in a clinical setting in a
sleep study, for example, at a university with
those people tend to be college students, those
kinds of people. Okay. Yeah. So, yeah, I mean,
so that's, and that's where, yeah. Um, so yeah,
I mean, generally that has been what it is. Right.
And like most of the studies that have been out
there have been, uh, young males. Right. And
so then there was, A couple groups that, you
know, have made the efforts to make sure, and
then now because NIH requires having, unless
you have a strong rationale for not, of having
males and females in studies. Unfortunately,
they haven't given more money to increase your
N, and so studies are still not necessarily powered
to look at sex differences, but now they are,
at least you can say there are males and females
in a study. So there's that generalizability,
but yeah, often still young. When I came out
here and working with Dr. Shea, his interest
was starting to look in sick populations, right?
So he was one of the first to have one of these
circadian studies in originally populations that
had sleep apnea to see if the circadian system
is impacting when you might have... And then
we move to individuals that had hypertension
or at least like this phenomenon called non -dipping
where your blood pressure doesn't drop as much
at night to again see how the circadian system
and sleep and other behaviors are impacting that
phenotype. And so moving in that direction, but
it is often challenging because you're still
trying to reduce the number of variables in a
study. So, yes, now you want to study with someone
with sleep apnea, but you want to make sure it's
truly it's sleep apnea. Maybe it's not diabetes
or something like that. So there's a lot of excluding
criteria still because either you have two options,
study lots and lots of people. So where you can
then model and. adjust for those different variables,
or you have a very clean group. Either it's hard
because it's hard to get lots of people to have
the ability to stay in a lab for seven days to
run these kinds of studies. But it's also hard
to find people who only have one disease or at
least like a disease based on the things we're
measuring for our exclusion criteria. but still
like needed in order to like tease those things
apart. So, I mean, those are the difficulties
of the in -lab studies. That is often why a lot
of studies have just done college students because
they have the time, they need a little extra
income. We have for our studies, so I've tried
to also following my mentor's lead, make sure
we have a more diverse group. that's part of
my community work is getting out there taking
the data back out to the community um in a conversational
way where we're teaching them giving opportunities
for them to ask questions to have some influence
on our designs of our studies um to be like just
to like break it down and what that could mean
is Having movie selections, for example. So when
they're not doing collection and they have time
to watch a movie, making sure that the movie
selection we have are things that people actually
want to see. Maybe increasing the comfortability
because it's just a hospital room. So putting
pictures up or maybe having a satin pillowcase
for individuals whose hair is more prone to drying
out if they just have a cotton sheet. Things
like that that make people maybe a little more...
um, break down some of those barriers to being
in a hospital for 70 is to do a study. Uh, so
yeah, so we've, we've worked to try to make those
studies more diverse, but it's, it's a challenge.
Yeah. Just finding people who have the time and
the ability to do that. One of my guests a while
ago made a really interesting point that I'd
never thought about before when, I mean, I've
been doing this podcast now for eight and a half
years and talking about shortening the work week
for fire service. And we'll get to that of course,
but I get told, well, show me the data. And my
first kickback is, well, if you need a study
to show that a 42 -hour workweek is healthier
than a 56, then you're kind of missing the point
of common sense as well. But that being said,
his point was, well, imagine if they actually
laid out a study, let's say a 30 -day study of
what it would like to be a firefighter, and you
did 24 on, 48 off, and then throw some 48 on,
24 off when you get mandatory overtime. ethically,
would a board even allow you to keep a bunch
of college students up for 24 hours at a time
every third day and add a 24 once or twice through
that month? And he was saying that I don't think
any ethics board would. So, and then please correct
me if I'm wrong, but the irony was we're told,
well, show us research when from his perspective,
it's like, well, in that clinical settings, no
one would actually allow you to even. put a human
test subject through that even though our firefighters
work those very schedules so yeah i think there's
in the past there have been some amount of like
sleep deprivation studies i think maybe even
like up to like 36 hours um and repeated and
so we've actually built some like modeling based
on those kind of studies that's what i think
it's getting more challenging to do that the
irbs are putting up um yeah more restrictions
so I would say like you had like one sleep deprivation
of like 24 hours, you would be allowed to do
that. I think you'd have to give a strong rationale
of how often you could repeat that. I think there
could be some level of it. I think honestly,
right now, the bigger challenges is like the
financing of those kind of studies. It's just
not possible these days. There used to be, the
NIH used to pay for shared services. And so when,
like, again. Steve, actually, even when I first
came here to OHSU, we could make use of research
rooms for free. They weren't free. They were
paid for by this shared resource. And the nursing
cost was also covered. And so you could then
you would just have to pay for the staff you
need to run the study and the equipment and people
for their time. And so that you could do with
a NIH four or five year grant. Now we pay and
the prices are going up every year. It's like.
over $1 ,000 for rooms, $99 an hour for nursing
time. So those are the things that I think are
probably the more prohibitive things. I think
if you made a good claim to a given IRB, you
probably could do some amount of cycling and
part because you could say, this is what people
are actually experiencing and we are trying to
understand what amount of sleep they actually
need to recover after having these. Especially
I think if you point to like the forest firefighters
who were like during very tight seasons really
are having large consecutive belts where they're
not sleeping whether it's because they don't
have the time because they're fighting or because
then when they're supposed to be sleeping they're
sleeping in hot tents if they're in the pacific
northwest they have long days so like the time
when it's actually dark is quite minimal um and
so they're not in an environment where they can
actually sleep so whether it's because they don't
have the time to sleep or because they just actually
can't sleep um It's happening, right? And so
I think you could make a strong case for the
need to run these kind of studies. But it's the
cost, I think, that's preventing it right now.
With these cuts that we're seeing at the moment,
what impact are you seeing on the research when
it comes to the fire service? Yeah, I mean, so
my research right now with the fire service is
funded through NIOSH. And that is a department
that has been gutted, right? enough people there
to make the argument that they haven't gotten
rid of NIOSH, but not enough people to actually
do the research or to do anything, right? And
so, I mean, we've done everything on our end
to try to see if we can keep that funding going
for the last year of it. We are also getting
ready to to write the second grant to follow
up on the work that we've been currently doing.
So we haven't started that process because we
just, since we're not even sure if the grant's
going to continue, we imagine it's not going
to be renewed. So yeah, it's having impacts.
We're supposed to have a meeting with the couple
of officials that are left on NIOSH next week.
So we're still hoping that some things will be
turned around so we can continue this work. But
yeah, NIOSH already had one of the smallest budgets
that was out there, despite everybody working
at some point in their life. We want to ensure
the health of our workers. We want to make it
to retirement. We're not just putting all these
hours in to die, which many, many people in this
country are. And so we need the research to show
what's working, what's not working, what needs
to be improved. When you look at the landscape
of research, um how hard is it to fund a study
that's simply showing proactive solutions versus
maybe one that's really kind of going to result
in some sort of drug prescription uh you know
the the proactive ones it is harder right because
i mean people want the solution of just like
not everybody but there's most people just want
a quick solution they want a pill that's why
we're seeing with the glp -1 right like everyone's
happy that we have a way to lose weight fast
down The problem of actual interventions, as
I was saying earlier, it's multi -level. You
have a lot more buy -in. It takes a lot more
time to go out and recruit people and build the
relationships so that way you can study them
to build the trust. So on the research side of
things, I have a lot of work to do on the front
end. Then I have to actually do the work, clean
it up, write it up. But then also I want to make
sure it's getting to the communities that...
are important that it actually matters to, right?
So not just writing for, you know, the occupational
journal of stress or something, but making sure
that I'm getting into trade journals as well,
that I'm going to both conferences because I
have to, like for the qualitative work, for example,
as I went to earlier, I absolutely, I love doing
qualitative research. It gives an opportunity
for people to speak. And a lot of times they
want to voice. what is is it isn't working which
i can't capture in a survey but traditional sleep
researchers don't necessarily buy that because
they're like oh people are just telling you what
they want i always push back on that because
that's what insomnia is insomnia until we have
a a sleep study that is able to um show that
there are different eeg patterns for someone
who has insomnia and and doesn't it is a subjective
disease. And so to say, oh, people's opinion
doesn't matter, doesn't make sense to me. So
I have to go make sure I'm going to the science
conferences to have those conversations and understand
where their pushback is. And often it's like,
are you sure you're controlling for sleep apnea?
Or are they just telling you what they want you
to hear? And then I also need to go to the trade
conferences. And those are, anytime there's a
firefighter, that is where I'm learning the most
because I am not a firefighter. And so I'm learning
from them what their challenges are, but also
how to communicate the research back. And they
want to hear it. They want it. And so but it's
just like it's a it's a lot more than if I was
just staying in a lab. Right. I I have many more
angles to get to. And then, of course, you know,
it's like you have if you have a union and you
have the department, you have. That's twice the
amount of relationships you have to build. And
then depending on the city, it's like if you
actually want something changed, right, then
you're going to a commissioner or a council person,
right? And that's another level. Maybe national
unions and getting the buy -in there. There's
just a lot more buy -in you need and understanding
on each of those levels of the barriers to implementation.
And then that's a whole other science. Science
of dissemination and implementation is a whole
other field of work and research that goes into
that and what actually works and what is needed
for someone to actually uptake and implement
an intervention. Is this still the case where
the metric for... sleep is still perceived tiredness?
Because I remember, is it William Dement, the
kind of grandfather of sleep medicine? That was
how they measured for the longest time. Obviously,
I know we have HRV and cortisol and some other
things now, but is that still one of the main
metrics that you use to kind of annotate if someone
is that well or not? So that's like insomnia,
right? That's what you need. So it depends on
what you're measuring. I think people are leaning
in to Daniel Bicey from University of Pittsburgh.
conceptual of the multi -framework or multi -level
sleep where you need to think about sleep regularity
and sleep duration and that also includes like
yeah daytime sleeping is how you feel so all
of those things go into what maybe is largely
called sleep health and so it's not just one
thing or another So now you kind of find yourself
entering the fire service. What, if any, was
some of the things that surprised you as far
as the hours that we actually work? So I think
some of those are more surprising things. So
I guess I wasn't surprised that, yeah, people
were waking up multiple times per night. I think
it was like the reasons when I start going into
like the actual kind of calls that are. that
are causing people to wake up um so yeah i think
that those are that it was that and then also
again this goes like into the culture so like
the sleep culture of it so there are many who
are like we're wearing the blue blocking glasses
and we're doing this and that to try to improve
our sleep but then sometimes it's simple as delaying
sleep time when they're in the station because
they're worried about a call that's going to
come in and um so i think like So working around
that, right, like that concern, I would still
like lean in. You're such a large sleep debt.
I can understand the concern. You're going to
wake up and it'll be harder to fall asleep. If
you're carrying a large sleep debt, you will
still be able to go back to sleep. And it's better
to, you know, advance your sleep time. So you're
actually in, you know, getting closer to eight
hours. Whereas, you know, if you're not even
giving yourself. eight hours in bed you're certainly
not going to get a full eight hours um but yeah
under but so that's where it come like the insomnia
comes in right like that worry and the rumination
and so um i think that that surprised me and
then again just the the kind of calls um that
firefighters are responding to that was the other
surprising thing i think one of the the lesser
acknowledged elements of The fire service is
the amount of hours that we work as well. When
you look at law enforcement, corrections, ER
physicians, all the other people that are out
there doing some sort of public service and life
-saving as well, it's pretty much usually a 40
-hour work week. So I think this is one of the
things that we really have to take a step back
and kind of unlearn that this is normal, air
quotes, is the fact that the... people that we
expect to come running to our biggest emergencies
are working 16 hours more than most people and
are grossly sleep deprived as well yeah the other
thing is and this is parts goes to like the education
or when we're speaking about this i don't like
everyone doesn't realize that a large percentage
of departments in this country also provide some
level of emergency medical service and i i was
just giving i was giving a presentation earlier
this year um where i forgot to note to that and
so i had a researcher in england who's like he's
like what did you account for sedentary sedentary
behavior because like most of the time firefighters
are just like sitting there in their station
i was like no don't you see where i have like
this graph or call volume what are you talking
about um but that's because at least in his area
i'm not familiar with england generally but for
his department that he was aware of um they don't
provide emergency medical services. So yes, they
don't have a large load than if they're truly
just only responding to fire. Yeah. So this is
the thing, you know, I think that we're seeing
now, it's as beautiful as a shift to a 42 -hour
workweek. So in Florida, as I sit here, the 10th
fire department just announced that they've got
one more hurdle, but they're basically about
to go to the 2472. Because, and we'll get into
this, you know, what you see in the fire service
prior to arguably a few short years ago is, well,
let's just move around the Rubik's cube that
is the 56 hour work week and change the days
around without having the conversation of, well,
why is this cube so big? Why are we even working
56 hours in the first place? Yeah, exactly. So
with that, let's get the exposure. I had Joel
Billings on, and I know he talked about his 4896
study, and we discussed it. The way that it was
laid out, understandably, when you're comparing
it to 2448 in that particular environment, in
that very, very quiet department, it was some
interesting data that came out of it. The problem
is that... massive urban departments looked at
that and then went oh that's the best schedule
and ran with it and i feel like we're now and
it's no fault of joel's whatsoever a little knowledge
is a dangerous thing as they say um now we're
getting people that have gone to 40 you know
48 hours without sleep and the huge you know
i mean arguably dangerous uh result that that
has when you're behind the wheel with you're
pushing drugs with you climbing 100 foot aerial
etc but that being said that all that aside so
What were, what was the first thing that you
kind of got involved with as far as shift work
within the fire service? Yeah. So I just mentioned,
so Joel and I were both, so I put on a, I think
it was called rest under fire. It's a panel at
the sleep conference on sleep and firefighter
health. And so he was on that panel as well.
So I saw him last week and then I'm doing something
with him later in the summer. So, yeah, I'm getting
to know Joel. But, yeah, so the Portland Fire
and Rescue reached out to us asking what is the
best schedule for their health. And so they had
done a literature review, but we went back and
did a literature review because at that time
I had worked with transit. So I was familiar
with that. And one of my colleagues had worked
with transit out here and nurses. So that was
the populations that we had previously worked
with. before that other than like my local fire
department did not know anything and so yeah
we just spent time discussing with them i had
a needs assessment with them that's also why
like i i i do focus groups and whatnot right
because i recognize what i don't know and so
first i was like well why like my first question
is why are you looking for a different schedule
like what is not working with so portland was
working the 24 48 and so we had focus groups
to learn what do you want for sleep? What does
perfect sleep look for you in the department?
What does it look like for at home? And we also
included family because it became very clear
that that is an important part about the, both
given that they're away from home for at least
24 hours, like the conflict that's there, but
then also that potentially introduces a conflict
when people are coming home, whether it's the
ability to try to fall asleep or because of like
the, FOMO of like, I'm missing out on things.
I want to be part of my family. I'm tired, but
I also want to be there for them. Right. And
so that just gave a great opportunity to learn
about all of that and the different, again, the
different barriers to getting sleep. And so from
that at the time, they were thinking about the
4896. It was specifically the wellness group
from the union that came to us with the recognition
that we are, there are some very busy. stations
here they could be up 48 hours obviously that's
not good for their health so can you give us
the data to show it and so as you're well aware
like literature -wise there are not purely just
like at the time there's one or two studies specifically
just looking at schedules but we leaned in on
the laboratory work and we actually worked with
andrew phillips who's out in australia to develop
models um based on the psychomotor vigilance
test that's Very common test that's been used
in laboratories to look at levels of alertness.
And then often that's paired with like subjective
measures of like how sleepy you are. And those
studies show that people are just not good at
noting. They just don't match, right? You're
objectively, you're going to be much worse than
how you feel. and so we we ran models based on
those focus groups those conversations we had
with firefighters on how much their sleep they're
getting if they're on a low call volumes department
medium and then we did like a high call volume
where for high call volume we're making the assumptions
that they couldn't take naps during the day and
have very disrupted sleep at night and then we
made the which I now recognize eight years later
is not correct, but we made the assumption, okay,
but at home, they're going to get eight hours
of recovery sleep. And so we ran those models
based on that. And the 4896 performed the worst.
2448 was the best. And then Portland had come
up with this alternative schedule that kind of
married the two worlds together called 1323.
So they moved from D's to our notation. And that
schedule was in between. And so the real issue
with why the schedules that give any amount of
consecutive time off is because, and so I should
pause and say, for those that are getting at
least six and a half hours of sleep on shift,
they were fine. There was no levels of high levels
of impairment. And so if you're able to get rounded
up to seven hours of sleep, then you'll be okay.
But for anyone who's getting in the moderate
and the high call where we said maybe they're
getting four to five hours, even just like losing
three, or four hours of sleep twice, it's really
hard to make up for the two consecutive nights
of sleep loss. And so even if they had four days
off, or we also built Kelly days and we had versions
of the models that included Kelly days. So for
the 24, 48, it's five days off or one, three,
two, three. I can't put, I don't know if it was
still five. I'd have to picture it. But we also
did like trades and stuff like that. So it probably
gave still times where people were like off for
seven days in a row. it still wasn't enough to
consistently make up for those also rather consistent
times of sleep loss um so that was all just based
on modeling though i came back we presented that
but we're like we're not fully answering your
question though you want to know you know you
didn't actually ask us about alertness that's
what we could do from the labs um you want to
know about your health like you want to know
about cardiovascular health you want to know
about weight gain like we actually have to do
a study to see because we don't know so yeah
so that's what we um did then they voted to give
it a trial period um and so yeah and so we've
followed them since then we're trying to generalize
it um because it is still just one department
and they um are more um I don't want to say the
answer, but like they have, again, like the individual
sleeping rooms, individual tap outs for calls
they have previously. And they still have like
fitness support, peer support based on Carrie
Kuhl's work. And so they have they do have a
lot of support in mental health, peer support
as well. And so we want to be able to generalize
that. So we've been able to do a couple of other
departments in Oregon and are trying to also.
bring in other schedules, so the 4896, the Berkeley,
to really just be able to systematically say,
this is the impact of consecutive days on versus
consecutive days off and show it quantitatively.
And again, because it's of interest for those,
again, there's the literature to show this is
the impact when you don't sleep, but to show
it systematically and the firefighter department
is our goal. What were the work weeks of the
transit people and the nurses that you studied?
How many hours a week were they working? Yeah,
I would say the nurses can, you know, there is
definitely some overtime there. And I would nursing.
I mean, on average, it's probably like a 36 hour
week, but it's very dependent on like if they
have a union versus they're not unionized. So
they can spread. But I would say on average,
it's probably about a 36 hour week, often in
like three 12 hour shifts for transit. It was
like a 40 hour week. Yeah. Yeah. So this is what's
crazy is, and, and this is, this is what I've
seen over and over again is when people have
this conversation again, we're spinning the cube
versus saying, well, another option is to do,
you know, have a D shift. And it's interesting
because in your area, the Pacific Northwest,
there's more departments than I realized that
have four shifts. Now they have debit days, which
again, especially Washington, especially Washington
is like, yeah, they're on it there. Yeah. So
the question begs, you know, why is that not
being. asked to be studied as well you know just
because we've done it this way i tell people
we've done it this way and then the ultimate
longitudinal study is how not to do it because
look at the ill health of our firefighters at
the moment look at the obesity look at the you
know even relationship wise you know the divorces
and all these other things i would argue we've
got a great amount of data but it's in the wrong
way so why not study a better version of it rather
than just keep moving the cups you know as it
were in the cup game Yeah. The other thing that
Washington does that, like, as I've talked to
other departments, and again, often it's like
because of union relationships, a lot of departments
in Washington have a limit on a number of consecutive
hours you're allowed to work on shift. So there's,
you know, the issue of like the 1323 or the 4896,
I've talked to people who are like, oh, yeah,
we have people who work 128 hours, right? And
the 1323. There's an increased amount of 72 hours
on shift. But yeah, in Washington, they're like,
you're not allowed to work more than 48 hours.
Like it's just a clear rule. And so, yeah, they
have been on the cutting edge. But yeah, I haven't
been able to study any of those departments.
Yeah. So this is the thing when people say, well,
have you got the data? I was like, again, no
one is studying the 2472. Now I take that back
because FSU is studying Gainesville and Destin.
They've got baseline, and now obviously they've
got to wait for a little while before they can
get some first -time round results. Then I believe
there's an organization related to Harvard. Again,
I don't think they can say they're Harvard because
of cuts and all that stuff, but I know they're
looking at one of the departments that's about
to go as well, Palm Beach. There will be some
data coming, but again, it really goes back to,
well, it's also what do you expect to happen
if you give these people an extra 24 hours between
their shifts? Of course. these things are going
to improve. And like you said, it's not the only
thing, but even like you mentioned the FOMO,
say you're in a quieter department, but you still
have to be gone for 56 hours. It doesn't matter
whether you ran calls, you're still away from
your family. So that's still going to have an
impact. You know, yeah. The more tired you are,
the more it's going to bleed over. But getting
our men and women home when they're supposed
to be, like the banker and the grocery clerk
and everyone else that works 40 hours, this is
the conversation that I feel that we need to
be really pushing in the fire service to stop
saying 56 hours is normal. And even, you know,
like the 1323. that's termed as days and it's
not a day you know i mean it's it's an actual
24 -hour day but it's not a work day you know
so we say one on two off it's like that's three
three eight hour days crammed together so that
would be uh you know three three six three is
actually what it would be so when we reframe
it in a way that people understand no no civilian
calls 24 hours one day's work just just we do
you know so i'm hoping this is you know joel's
talked about it and sarah jenky they're kind
of I think they're going to be pushing towards
researching some of that side now rather than
looking at this 56 -hour week that we already
know the impacts of that because we see it in
the ill health of our people. So with that being
said, I would love to, through your eyes, kind
of unpack some of those ill effects. So whether
it's in the fire service or whether it's previous
occupations that you've studied, let's start
with mental health. What is the relationship
between mental sleep deprivation, excuse me,
and mental health? Yeah, I would say that's probably
the strongest relationship or what we have data
on, right? Like there's a very clear relationship
between mental health and sleep disorders. And
even just like object or subjectively, it's something
that people can easily point to. It's like, even
if they can't. and inherently say, oh, yes, I
am sleepy, they know, okay, I'm a little more
irritable. I'm a little more moody right now,
right? And so, yeah, I mean, that is one of the
clearest relationships that we've been able to
identify. And what about like more chronically?
I mean, I know there is a lot of research out
there, but have you yourself seen the impact
as far as, you know, suicide, addiction, some
of these, you know, more chronic and deadly elements?
Yeah, so I haven't like I the for suicide measures,
we haven't captured that. But yeah, I mean, but
yeah, for like the mood and things like that,
we certainly do see it. That's one interesting
thing about the and this will, I'm sure go on
with the 2474 is like that for the 1323, the
ability to have like that consecutive time at
home. So even if they are more, you know, have
those 48 hours. that ability to have like more
time away from work that they're able to detach
more um they're able to um engage in more mastery
skills right so i think like and this is one
of those things whenever i talk to academia it's
like well did you account for them working second
jobs and and i do push back on that because yes
that happens but it happens one because maybe
financial concerns maybe that their department
doesn't actually pay like a living wage um but
then often people are just doing things on their
time off that might be also working right taking
care of children needing to be a caregiver of
maybe children and um a parent right um and then
some people just have hobbies that are equivalent
to people's jobs like there are people who do
construction for fun but then there are people
who are doing construction for paid work so i
i think if that is a concern then we need to
do a better job of like that needs to be written
into the policy you're not allowed to do this
on this day off um and so then that's a mutual
understanding or having some type of fatigue
management system in place, which maybe will
also promote people prioritizing sleep at home
because they know that there's going to be a
PVT test when they come in. And implementing
that would also show that across 24 hours, that
is deteriorating. And again, we need the proper
recovery time to boost that back up. Sorry, I
lost what I was originally going to say. Oh,
so yeah, we see that with those three days off,
people do have work -life balance is improving
both for the spouse and for the firefighter.
And that they're able to note that like their
social engagement is better because they are
able to have more of it. I remember even just
like, again, going back to like qualitative work,
it was a concern, like go. firefighters on the
1323 not everybody wanted to move to it some
were concerned that they're going to be away
from their home for 48 hours sometimes um but
then on the back side it's like actually this
has worked out better like my relationships improved
um My, you know, they, they, they figured that
out. And it's like the, having the more time
at home has been more beneficial to make up for,
you know, those 24 hours or so when they're not
to the point where like 96 people, percent of
people are, they want these other schedules.
Even before it was like 70 % were like interested
in thinking about it. Some of them still like
cautiously. So, but then it was like, nope, we
like this. i think the four percent comes from
those with really high call volume departments
which i keep coming back to like that is an issue
like the volume needs to be addressed and um
and then individuals who are divorced right like
having to renegotiate um agreements with uh their
exes and things like that Yeah. Yeah. It would
be interesting if you put them, you know, you've
got the 2448, you've got the 1323, or you've
got the 1313. Which of these would you like?
Yeah, of course. You know, you know, that was
like in the qualitative work is like, this is
great, but we would like, yeah, so. Absolutely.
Well, it's interesting as well, because you've
mirrored what I've heard from people. And it's,
it's, it really does kind of anger me because
when someone arguably who usually works nine
to five, 40 hours a week says, well, if we give
our firefighters more time off, they'll just
work on their days off. I think that's a very
arrogant thing to say that you control people
even when they're not wearing the uniform. But
especially when the lack of leadership has contributed
to holes in staffing that these men and women
are filling, that is their overtime. That is
why they are working more. So if you create an
environment where recruitment goes up again and
you fill all these spaces, Well, then you've
solved one part of that immediately because now
the people are only working the shifts that they're
supposed to be working. The other thing as well,
and you said it yourself, when... There's two
types of working on your days off. There's irresponsible
working. I'm going to go work overnight in the
ER. I'm going to work for a private ambulance
company. And there's responsible working. I'm
a landscaper. I'm a personal trainer. I'm whatever.
And I'm going to work during the day and I'll
be home with my family at night. I'll be tired.
I would have had a different community that I've
been working in. So building even more relationships,
I'm going to be healthier and happier. And I'm
going to sleep like a baby that night. So understanding
that, yeah, having something in place saying,
you know, you are not allowed to take a job that
will keep you awake all night for yet another
day. I couldn't agree more with that. But saying
you can't work on your days off, completely wrong
way of doing it. Yeah, I should have written
it down. There's something else there you said
that I was like, oh, I know. So we're just going
back to the one, three, two, three. So the other
reason why I should note that. The reason Portland
went with that schedule is because they feel
like it's a way for them to be able to get to
the 1313. So that is their goal. And it's a way
of like just do negotiations over time that they
can get there. And so they have already moved.
So they used to have a Kelly Day every 13 shifts
and now it's every nine shifts. And so with those
negotiations, that gives like the department
or the city time to budget or whatnot. But but
the recruitment levels are issues because like
there was a report that was like, you guys are
still massively understaffed. And then there's
going to be a huge retirement wave coming up.
And so I'm not sure how they're going to actually
get there with the numbers without like still
just having mandatory overtime, which then they're
not moving towards that actual direction. But
that is their goal. You have like them trying
to make that work. It's I mean, it's so weird
because I'm who am I? I'm an immigrant from England
that became a firefighter and never rose above
that rank. But. And listening to people like
yourself and all these other people and working
for various departments and getting a kind of
East and West Coast perspective, gypsy firefighter,
as you were, you're on the outside looking in
more. And so when people say kind of knee jerk
things, you get to step back and go, but that
doesn't make sense. And one of the things is,
well, for example, the departments that have
three people on an engine or a truck, and they're
like, we want to get to four person staffing
first, and then we'll look at the 2472. And I
tell them, you've got it completely backwards.
If you are struggling to hire people now, what
makes you think you have the staffing to add
a Kelly day or to add an extra person on the
truck? It's the other way around. Create the
environment that excites young people to put
this uniform on, and then you will have the staffing
for the things that you're looking for. So the
departments that have done it really well. And
very few departments can say, hey, we're going
to go to it and just go to overnight. Of course,
it's got to be the size of the county or city.
It's going to take a few years. But they announce
we are going to the 24 -72. And then we are going
to take three or four years. The year one will
be a six -day Cali day because we'll hire the
people to fill those positions. Then a three
-day, then a D -shift with debit days, and then
a full D -shift. And so this is, I think, what
people have got to get their head around is that
you've got to draw a line in the sand and say
enough is enough. Because if recruitment is bad
now and you're not fixing anything, it's going
to be worse a year from now, even worse two years.
So the exciting thing is a solution is the very
thing that's going to improve everything from
saving your city money to improving the health
and relationships of your firefighters and their
families. It just takes the courage to say. We've
got to be proactive. Like we're talking about
the research, you know, the proactive is the
hardest fight, but it's actually the one that
makes the most sense. So what about on the chronic
disease physiologically side? We talked, we touched
on mental health for a split second. You were
talking about the impact on the metabolism in
the rat models. Talk to me about the impact of
sleep deprivation on, you know, obesity, hypertension,
diabetes, those kinds of areas that we see so
prevalent in the fire service. Yeah. And in part,
it's related to the mental health, right? Like
if you don't feel as well, you're going to be
less inclined to go, probably less inclined to
want to eat a salad, but let alone like prepare
vegetables and fruits. You just want to find
something that's not just like quick and easy,
but going to be quickly satisfying, right? Which
is going to be like those high dense foods. You're
going to want more sugar, more fat because those
and the immediacy feel better. And then there's
also just like research to show that you don't
process it well as well as if you're You know,
eating later at night, whether that's because
of like circadian timing that your body's not
set up to process it at that time or just because
you're up more hours. Yes, you are burning slightly
more calories because you're up for more amount
of time, but not to the extent of how much you're
putting in. Usually you're eating much more,
especially at that time of night, because, again,
you're more likely to eat those high dense foods
than. you know, at 10 o 'clock at night, you're
not going to go grab a salad. And so over time,
those things are going to impact, you know, weight
gain, lipid levels, your ability to process sugar
leading to diabetes, what have you. Yeah. Yeah.
I mean, from what I understand as well, like
sleep deprivation. creates issues with insulin
so you you know the chances of getting pre -diabetic
ultimately diabetic are increased you know your
leptin and ghrelin is all over the place so like
you said with the hunger and then you know with
with i mean both sexes especially men the testosterone
depletion that we've seen with sleep deprivation
as well exactly and you know the best way to
you can prevent that by sleeping and so yeah
people are leaning in on the supplements you
can't go back once you start that but like you
can prevent it by by having proper sleep absolutely
so okay i'll put this to you again because you're
obviously taking what you've seen and then the
uh the chronic and um acute effects of this um
if you gave an extra 24 hours after every 24
hour shift so you had a 72 hour period what impact
would that have on the likelihood of obesity
and some of these other diseases that we've seen
Yeah. So this is all like speculation based off
of the research. We haven't we haven't done that
yet. But yeah, I mean, as long as people are
actually working to sleep more than eight hours
to make up for that loss, then, yeah, I could
say we could reduce those harms. I think part
of the problem right now is like for all of our
objective measures of sleep, on average, firefighters
on their days off are getting about seven hours
of sleep. That first day off, they'll get about
seven and a half. So still not, you know, eight,
nine, which you would hope. you know eight regularly
nine to make up for that lost sleep and it doesn't
have to be consecutive right like that's over
24 hours so take a nap when you get home and
then try to go to bed a little bit earlier than
whatever your habitual sleep time is um to get
so to make up for that right so there's no research
that's clear on how much additional sleep you
need to make up for lost sleep but that's only
because like we haven't had studies where you're
in the lab for like 48 days to see like When
we're, again, doing back to the beginning of
the conversation about some cycles of sleep loss
versus recovery sleep. But you want to get more
than the seven to eight. So on your days off,
you need to find time to get closer to nine that
first and then eight the others. Because right
now it's like we see seven and a half on the
first day and then like six to seven on those
other days. So some amount of education to make
sure people are aware. I'd say temporary. you
know maybe keeping a sleep diary on those days
off just to like be aware because sometimes people
are just you're just used to whatever your routine
is you might not not actually be aware and you're
so used to being tired that it's it's the same
right and so um the best way to know like how
tired you are is if you're on vacation and you
have any amount of time to sleep are you consistently
sleeping more than eight hours if so if so like
you are deprived in sleep and you need to to
work on that so um i would say if people are
getting improper sleep on those days off yeah
i would say we could see a serious um reduction
in those harms like you and the other thing is
to get the regularity right so going back to
not just duration um and how you subjectively
feel but regularity and i would say firefighters
or at least those in portland where's where i
have the most data on that um are somewhat good
about having like regularity right so that's
where they're not like nurses maybe who are working
like purely night or something like that. There's
some decent amount of consistency. So the sleep
regularity, we're doing the sleep regularity
index. It's from zero to 100. Research shows
if you're like 60 and below, that's where you
have an increased risk of mental health, chronic
diseases. And so my firefighters in general are
about 70. So not perfect. Like I would probably
be like 95. I'm pretty consistent in my time
in and out of bed every day. But they're about
70 because. their mid -sleep time is pretty similar.
Now, again, that's probably because when they're
on shift, they should be going to bed a little
bit earlier. And when they're at home, they should
be going to bed a little bit earlier. And that
would really help, I think, to increase both
that sleep regularity, but also overall duration.
And I would say with those two things combined,
we could see improvements in health. What about
cognitive acuity? You know, we talk about the
chronic disease element, and that is huge. And
I mean, I just saw a local firefighter just died
of cancer yesterday. So that's prevalent front
and center. But if you look at, again, life safety
and then also liability. So we're putting a dollar
amount on a sleep deprived. firefighter whose
cognition isn't where it should be, you can only
imagine, you know, the intersection wrecks and
pushing the wrong medications and intubating
the esophagus and all the things that are going
to have, you know, millions of dollars attached
to it. So what have you seen as far as a relationship
with sleep deprivation and cognitive acuity in
whatever professions you were studying? Yeah,
and that's, I mean, I have stories from like
nurses that talk about like, I think there was
one person who noted like they would on their
way home. And this is where again i think like
this goes to like the safety culture right if
you have a culture where it's like okay to take
a nap before you go home um you could reduce
these but talking about like you know having
their hair in a ponytail and having it tied to
the sunroof so that way if they nod off on their
sleep they'll feel it right like that's intense
like the thought process to be like i'd rather
do that than just pause going home um Or again,
other ways we could alter schedules to prevent
something like that altogether happening. But
yeah, I mean, it is a problem. And the cognitive,
apart from like the mental health, is a place
we can see it, right? That's the one nice thing
about that PVT, that psychomotor vigilant test,
is that we have all this data from years of in
-lab work, and now we have field versions of
it. And so it's a nice way to like compare the
two, all the years of studies of sleep deprivation
to the real field. And so, yeah, in the firefighters
I study, they have a large number of lapses more
than maybe like the general population that has
acute levels of sleep deprivation. They consistently
have really high levels. And so even we see that
more days are on shift. Those number of lapses
increase. The more days at home, they decrease.
on average everyone's doing bad like everyone
on average is carrying a large amount of sleep
loss and we would like to see those number of
lapses in general come down um but yeah just
yeah there is a large impact and again i just
i when people are that chronically sleep deprived
you just don't even realize it right your mind
plays tricks to like keep you going and so if
everyone just went on a nice two -week vacation
and like really slept to see like oh this is
what it feels like to like get a proper amount
of sleep um Yeah, I think it could do a lot of
good. Well, going back to the study that we were
talking about, it's interesting. I've had Kirk
Pastey on the show as a Navy SEAL that ended
up getting into sleep to figure out what was
going on with his SEALs after he came out of
med school. And then I think Matthew Walker's
book quotes this as well, but that 24 hours without
sleep is like having a blood alcohol of 0 .1.
And that's, again, if I think about where that
was studied, it was probably... largely well
rested college students that were, as you said,
sleep deprived for a single 24 hours, and they
got that. So imagine now that times 30 years,
and then you put in mandatory overtime, what
blood alcohol are some of our first responders
really walking around with? Yeah, exactly. So
yeah, and then I mean, to combine that with like,
because I don't I mean, you had mentioned about
I think, like, behaviors, right? But like, alcohol
use is also very high um on days off and so that's
preventing again like that nice restorative sleep
that we need um i know it's like often used as
like a as a coping mechanism and maybe initially
as a sleep aid did you fall asleep but the it
is having consequences on the sleep when um at
home as well though absolutely just compounding
it well One thing that came out of Joel's study,
the 4896, with a department that run less than
one call a night, so arguably they slept most
nights, was they saw the benefit of the second
24 hours of the 48, because the first one, as
you kind of alluded to earlier, myself included,
I used to get up at 5 o 'clock in the morning
to drive 70 miles to go to my station most of
my career. And he was talking about this, Sarah
Jenke was talking about this, the prevalence
of some sort of seed deprivation at the beginning
of the first shift because of our start times.
Not instead of, but along with the 24 -72, I
think changing the start times makes so much
sense because unlike a lot of jobs, we can turn
the dial. It's a 24 -hour shift that we work,
so we can start whenever we want, start and finish.
in my opinion i think the 11 a .m 12 noon would
be the absolute sweet spot because the people
going to shift would actually be able to wake
up with their family have breakfast take the
kids to school and then go to the station the
person who was coming off who got murdered all
night can actually sleep in a little bit catch
up on maybe one more sleep cycle and therefore
make their commute home a lot safer as well.
So what is your perspective or any science that
you've seen as far as when we wake up and the
impact of that on our 24 or 48? Yeah, no, a hundred
percent. Like the, that is that first, um, that
first day on, uh, whether it's 24, 48 or the
one, three, two, three, yeah. Everyone shortens
their sleep. That is the night they actually
get the least amount of sleep because they have
to come on and you know there's people who have
large commutes from home to their station um
so yeah we see the same thing and then we also
see on that second 48 that people are sleeping
in a bit more um it's like 15 minutes more and
i think that is something that we could work
to improve on in part because um on that 48 for
whatever reason people are also going to before
that second morning people are still going to
bed a little bit later um and i think that could
align with chronotype right like so they're able
to sleep in or they're going to bit later because
they're thinking oh i'll be able to sleep and
i don't have to get up right so i think that's
just with education and showing them that that's
what's going on i think we could improve upon
that and so i think they could there's there
are a few opportunities when on shift for those
48 hours if necessary to improve sleep there
and then just making sure that all stations are
buying into they don't have to be at 7, 8 a .m.
or whatever it is for a roll call because we
did that the prior 24 to make sure there's some
consistency there. So I think that is an area
that could be intervened on. And then, yeah,
more notably, so yeah, I know like, yeah, Sarah
Jenke's studying that more broadly, the shift
start time. And I know that Joel has some recent
outcomes on that. And yeah, I think it's great.
I had, we like out in Oregon, we had previously,
we had included those questions, but they hadn't
thought as far as like 11. It was more like,
do we want, I think the answer might've been
like seven, eight, nine, or 10. And most people
were happy with the like 8am because going to
those later times, then there is issues with
like the benefits, I guess we're like not outweighing
them. in terms of the ability to help with drop
-offs and things like that, or the ability to
be home in time for a drop -off or a pickup.
But I think, yeah, we switched a little bit further
to the 11 or 12, which I had never even thought
of until I saw Sarah and Joel's work. But I was
like, all right, that would get rid of that conflict
and allow for people to sleep in. Because this
is a more common question now. I was talking
to some departments that did more like 5 p .m.
And I was like, yeah, that could also work. Or
there was one group that was talking about 7
p .m. because they could have dinner at home
and then come in for the transition. And then
the others would come home and then also have
time to sleep that night. And I was like, yeah,
those are all things that are outside of the
box. And I think get rid of some of those concerns
around like the 9 or 10 o 'clock, which is what
I previously saw in discussion. Yeah, because
when I was reflecting, On the 2448, I only saw
my family one out of three mornings. And so if
you change it to this, that would change that
to two out of three. Or if you did a 2472, three
out of four. So I love that. And the conversations
before was always, oh, we'll just do PM then.
And again, like you said, no one was thinking,
well, what about in the middle? And it's because
it kind of smacks against, you know, just the
way that we've been conditioned. But it really
does make the most sense. And for me personally,
if I had to work at 7 p .m. I wouldn't be able
to enjoy that day because all I'm thinking about
is I got to go to work. You know, so we already
want to go out and, you know, have dinner and
have a glass of wine. No, I can't. I got to go
to work, you know, versus I still get up. I still
go technically in the morning to the station
and I get there. I do my checkout now instead
of breakfast, it's lunchtime, you know, and then
conversely, when I go home that next morning,
because they've got rid of the, you know, the
roll call kind of wake ups. Now I've stepped
through and like I said, I've gained sleep there
too. So, and that's a completely free. All you
got to do is just get people to buy in. And yes,
if you did it one way with an 8 a .m. or 7 a
.m. start, of course, you're going to have to
figure out things a little bit. But I guarantee
you, once you get those changes done, you know,
that extra sleep, like you said, and that reduced
stress, you know, would be another amplifying
factor on this health conversation. all right
well i want to hit one more area and then we'll
go to some closing questions um thc i saw you
did a study with that and sleep now i'm a big
fan of any you know safe plant medicine that
is going to help someone you know whether it's
cbd whether it's thc for certain people it's
not my particular you know jam but I've had Dr.
Bonnie Goldstein on the show talking about so
many benefits from THC. What were you finding
as far as that use and sleep? Because I've heard
varying stories from some people saying it helps
with sleep, some people saying it makes sleeps
worse. So I'd love to hear the actual research
that you saw. Yeah, so that is the other 50 %
where I spend my time is on researching cannabis
and cannabinoids more broadly. So I've also got
a phase one study. using cbda which is actually
the precursor to like all these others it's like
the godmother of cannabinoids um and i'm hopefully
supposed to have like a nice r01 study starting
july 1st i haven't gotten the noticeable word
yet so anxious about that um that'd be to run
like a really nice large study to look at all
of this um but from my work right now which is
like based on epidemiological work i'm looking
at like thousands of people um those that chronically
use so that's 16 days or more per month um it
resulted in um abnormal sleep times, right? But
we were supposed to get between seven and eight.
It was resulting in either two, like a little
less than seven or more than eight. And that
in part depends on age. But still not in that
ideal world. And then in our lab studies, where
they're like under review right now. We run this
as one of those like in lab studies where we
were very controlled. So we had people sleep
habitual schedules before coming in to make sure
that they were circadian aligned. We had them
keep a low -fat diet a couple days before coming
into the lab because THC is lipid based and so
it would linger more if they previously been
using and at the same time when we gave them
THC in the lab we gave it with a high fat snack
so that way we could try to equal out how it
was being digested among everybody. And so among
those that chronically used at home, when we
were measuring at home with actigraphy before
they stopped using, we saw that their sleep was,
they had less sleep on average compared to our
controls. And then when they came into the lab,
we didn't see huge differences, but we didn't
see any benefits. So the idea is that like that
had kind of been out there is that, well, chronic
use is bad, which. we've shown but that there's
still some benefits maybe acutely people could
use but even in those that had never used when
they were given a very small small for a regular
user but like appropriate for a first -time user
um we didn't see any benefit um some people had
increased sleep latency um they um the one thing
we did see which we've other studies have shown
was that in REM 3, so your slow wave sleep was
slightly increased. However, we went and looked
at microsleep architecture, which previous studies
haven't really looked at. It's like the power
of your deep sleep. We saw that it started off
high, but then kind of stayed across the night.
So the way we're interpreting that is that, yes,
there is more, slightly more. slow wave sleep
but that's because the quality isn't as good
right so your your body's making more of it because
it's not really working the idea is that this
delta power in the beginning of the night should
be high because you've been awake all day so
you're tired that should once you start sleeping
that should quickly go away though and we're
not seeing it go away even with just a small
amount of cannabis used for the or thc the first
time we're seeing it just like stay um which
Often after people do use, the morning they'll
wake up, they might say, oh, I slept really well,
but they're still sleepy, right? And so maybe
that lingering sleepiness is because they didn't
actually dissipate the thing that's supposed
to dissipate, the reason why when you wake up,
you're not supposed to be sleepy. So yeah, so
we're not seeing any benefit. And so we're trying
to, that was a small sample. Ideally, we'd like
to increase that sample and also look at different
dosing and then mix it with CBD because there's
always the idea that maybe CBD is attenuating
some of the negative consequences of THC. Really,
I think the animal work actually suggests that
THC is more alerting, or CBD is alerting, but
we haven't done those types of studies in humans
yet. What is the research that you found when
you look into CBD specifically on its own and
sleep quality? So I haven't studied that yet
in humans. That is, yeah, a goal moving forward.
And then the problem with the epidemiological
world is that no large study is asking that yet.
And that's even the problem with the cannabis
use. Is that they're not asking it in a way that
people are really using. So we published based
on the epidemiological data. So it was just,
again, like how many days a month are you using?
And we do see that people who are using greater
amounts are having at least poorer sleep durations.
But yeah, they're not asking about CBD use, let
alone co -use or anything like that. And yeah,
so and the research funding is just slowly starting
to get there. i will say one thing though when
we like measure blood of people who use cbd levels
are rather low um so it still is thc is really
still the predominant um if we're talking about
like someone who's just smoking it's really is
thc um and so yeah we haven't yet studied someone
who's or people who are just you know just taking
cbd interesting i will say the other thing about
cbd though and again this is all just me based
on what i know in the literature and not a study
i've run but for the things that cbd is like
fda approved for the studies that have shown
cbd to work the amounts are much higher than
what people are getting if they just go to like
a wellness store or whatnot um so yeah so to
be aware of that um the dosing isn't really equivalent
so i guess all that says i sometimes i think
some of the cbd stuff is placebo but we need
to run a study to see yeah there's a there's
a great company rescue one cbd um john for is
the the creator and he's a firefighter here in
Florida. And he, I mean, took a big, big, deep,
excuse me, deep dive into the research and even
the quality of his product. But he was saying
the same exact thing. Like there's a lot higher,
um, strength in the one that he uses. And I've
actually used his sleep formula and it's got
the, um, the name just fell out of my head, but
all, all the elements of lavender and some of
these other things that we know help with sleep.
in the, uh, in the actual formulation. And I
can say for me personally, it helps. And then
also, um, Ashka Wanda, I've just started taking
that and that seems to help too. I have a colleague
who's studying that she's actually has a, like
a mini panel that she's doing right now on that.
Yeah. So even that, but so I was taking it and
at first it seemed like. I don't have to describe
it. It was almost like a restless mind while
I was asleep. And then my wife kind of, you know,
just simple Googling. And she's like, oh, actually,
a lot of people are saying, don't take it right
before you go to bed. Take it earlier, you know,
in the evening. And I shifted that and that helped.
So just like you're talking about, you know,
it's these little nuances with these. these studies,
like nothing is black and white. Like, you know,
is it going to work at all? Maybe not. Or, you
know, are you taking it at the wrong time? Or
did you eat the wrong thing? Yeah, and that's
why I'm like, oh, again, like back to like the
firefighters, like we need, especially for the
cannabis stuff, I think they're just, there's
a whole lot more research that needs to be done
because like, whether it's CBD or CBDA, like
we just don't really actually know. CBD, we know
more now because of epidiolex and other. uh there's
been larger clinical studies but all the other
cannabinoids we know like absolutely very little
um so we don't even know that proper dosing which
is why i'm like running this phase one study
um but it's just like it's all it's all out there
let alone like the best timing of use the best
should you i mean obviously if it's gonna be
medically prescribed no one's gonna say you should
smoke it but um but then we actually need to
have more studies on the oral for uh formulations
um yeah yeah it is yeah it's interesting it's
also challenging because like yeah this like
the uses patterns of like that you're you know
often people are going to like drink and do that
or something like that right so like define populations
that are clean to study just uh cannabis uses
is also a challenge but so what do you use personally
with all this background in sleep and you know
studying some of these supplementations now what
is your kind of sleep routine in the evening
yeah i I think regularity is like what I use
the most. So like I will have like a cup of coffee
in the morning and then very rarely will I have
anything after lunch. So that's probably what
I do the best. I try to get daylight, like make
sure I'm getting lots of sun during the day and
being here in the Pacific Northwest in the winter,
that's hard, but I make sure I go on like a walk
for at least an hour during the day to make sure
I'm getting light during the day. And then at
night, yeah, once like I have a three -year -old
and a seven -year -old and like once we... Getting
into that nighttime routine, like lights are
red. And even in their bathroom, the light is
red. So they have to get up in the middle of
the night. They're not getting exposed to light
at night. So in like our bedroom, we have like
red lights at night. So yeah, so I reduce light
at night, make sure I'm getting light in the
morning, reduce caffeine, you know, try to keep
alcohol to a minimal, especially in the evening.
I'm actually like more of someone who would.
have it at brunch or lunch then later in the
day let my body process it during the day so
it doesn't disturb sleep um yeah and then try
to keep a cool i do like the summer's been harder
um but yeah i keep a cool bedroom but then i'm
also like someone who likes like a heated mattress
though because i feel like that helps like peripherally
dissipate energy so your core body temperature
can reduce um that's the other thing i do There's
something actually just while you're sitting
in the Northwest talking about the winters. I
was thinking about this the other day. I'm in
Florida. So our summer days are extremely bright,
extremely long, from 6 a .m. to like 9 p .m.
basically or 5 .30 even. And I was thinking when
we're talking about the chronoreceptors, obviously
there must be an expanding and contracting element
to the circadian rhythm throughout the year.
So what have you found as far as that? And then
the impact of being someone like the you living
somewhere like the UK or the Pacific Northwest,
where maybe you don't, you know, have those those
long days like someone, you know, closest to
the equator like I am. Yeah, so like in terms
of the seasonality, I haven't so I, I always
record it and all my stuff, even the firefighter
stuff, I record it and in part because it's behaviors
are very different. Like everyone's camping out
here in the summertime. And so they're getting
more light just from that. It's been something
that I'm aware that I account for, so I account
for month in all of my analysis. We actually
are starting to do some, not in the firefighters,
but with my canvas work, actually measuring the
ability to suppress melatonin. That's as far
as that goes, but in terms of what I do, as much
as I'm saying, okay, we'll do red lights at night.
We will also use blue lights in the morning and
the winter because our days are extremely short
out here. I'm outside, but what is the lux exposure
we're actually getting? It's rather low probably.
I account for the lux exposure. Even in my lab
studies, a lot of the canvas work we did was
in dim lighting because we were just controlling
for that. And so, yeah, so I'm aware of it. I
control for it or I modulate it. But in terms
of like, yeah, I don't know if I'm like fully
answering the question. Yeah, I just it was interesting
because if you took a Floridian and someone from
Portland and then you again did a air quote study,
you know, that obviously they would be in completely
different places. So even where you're standing
on the planet is going to impact your circadian
rhythm. And I would I would assume even the length
of your sleep night. Yeah, so it's like something
that in that and temperature are things that
I'm increasingly starting to collect because
it is an interest. And I've been thinking about
that as well. Well, one quick thing, because
I remember when I was looking at some of the
studies you've done, some of them were specifically
regarding black people. So what caused you to
kind of lean into that? And what were some of
the findings as far as an actual ethnic population
and some of the health outcomes that you were
studying? Yeah. So then that was going back to
like talking about like diversifying our studies.
And I was mentioning like, oh, we have satin,
you know, quals or things like that. And part
of it was to diversify the studies. Right. So
one of the some of the outcomes we were looking
at were, again, going back to the blood pressure.
Right. So the non -dipping blood pressure is
more prevalent among African -Americans. But
those aren't the populations we're studying it
in. Right. So we were studying the question we
have. if the outcomes are related to that we
should be making sure they're included in our
studies we had done like a review one of the
first things i did when i joined i came here
to work um we were looking at the timing of blood
pressure medications the number of african americans
in those studies were so so low but that is the
population that is most prevalent not only most
prevalent but at earlier ages like you know talking
about late 20s early 30s having hypertension
but they're not part of the studies right so
that's that became the rationale there and again
like why I spent quite a bit of my time actually
doing like community work because so I also started
this talking about how like I'm up on a hill
OHSU we're the only medical college in Oregon
and one of the few in the Pacific Northwest there's
like three so we we have a large spread but people
don't necessarily like to come up here, right?
It is out of the way. And so it takes work to
get off our hill, to communicate the research,
to build the trust, to get people here and, you
know, do all that work. And the numbers are so
small that we're able to get here, but it's important.
So, so yeah, so that's the rationale of doing
it. But then also going back to like the comments
we had, so it's nice for coming full circle.
It's not just genetics, right? Like the reasons
why oftentimes that African -Americans have these
outcomes are because of, like in Portland, for
example, there's a large history of redlining.
And so there's just generational trauma that
has been present. And also the reason why there's
mistrust with organizations like OHSU. And so
it takes time to break those things down, but
also have to measure those things, right? And
so we have a lot of measures of stress in the
lab. And so what we've analyzed right now isn't...
Based on race, it's based more on stress. And
so we look at people who have a history of stress.
We can measure that in a few different ways,
but it's more like we have this measure of cumulative
stress over one's lifetime. And we can see that
those that have larger amounts of stress have
blunted. it can go both ways where you can have
like a magnified, but this are outcomes we've
had for some of these circadian measures. So
if we look at like the circadian rhythm of cortisol,
it's blunted. And so the consequences of that,
we're not sure yet where we have some other measures
that we're still seeking to look like inflammation
and things like that. But we know that it is.
abnormal response and not just baseline but if
you actually then stress someone out further
with um in the lab we do like this mental math
test and then you also have to put your hand
in cold water so like a very robust model we
see that it's just they have a blunted response
to that as well um so that could be it's not
a negative thing right sometimes um your body
adapts and so the adaptive response to having
a cumulative stress in your life is having smaller
responses to an acute stress um but that could
also be detrimental right if you if you're waking
up right because even just waking up is a stress
to our body you're going from supine sleep to
having to um you know get all the muscles moving
and in order to stand up to order to think to
order to go get a meal of our hunter -gatherers
right making sure we're having all those things
necessary to start our day and get energy to
keep us going um you maybe need a bigger response
rate to hit external demands that are coming
out. So it could be adaptive in the short term,
but could be harmful in the long term. So we
don't have like definitive outcomes. We do see
that there is an irregularity going on. And we're
still trying to further see how that could be
impacting blood pressure and the inability for
some to have their blood pressure drop at night.
When you say redlining, explain to me what that
is. So so there was so it's these old maps for
like like housing and like the pricing of housing.
Right. And so they would have this is where I'm
like, I'm not defining it the best, but essentially
there would be there would have like this is
where people should live. And like these would
be the prices of these houses. And so it pretty
much like. resulted in the African -American
community here living in some places and the
inability of them to live in places that would
be more desirable. And that would, again, help
build that generational wealth, right? If they're
not able to buy the houses in the nicer areas
that have better resale values, then when they
pass away, they're not able to pass that on to
their children, right? And so then, yeah, so
it's just a way of propagating. And actually,
there was like a recent thing out here in Portland
where there was something similar. So in Facebook,
you could like for advertising, for example,
you could. And I honestly, I would use some of
these things to help recruit diverse populations.
And so you could use I think you could just say
you were interested in the higher black population,
but you could also then say you weren't. And
so even right now, there is a company for. I
don't know if it was apartments or whatever,
but they were purposely trying to not advertise
to black individuals. And so in Facebook, you're
no longer able to do that. And it was because
of like that reason. So that's like a modern
day version of redlining. You're keeping certain
populations out of certain residential areas.
yeah well facebook's anyway i can tell you that
way yes yes because older people still use it
so for certain studies it is a good advertising
tool and so it's like a way to get messages out
there but but yes yeah agreed well i can tell
you they've redlined james geary because i have
30 000 people on the behind the shield one and
then like 5 000 on the personal one and i will
do a post and most of my posts are about you
know solutions and advertising the podcast and
all that stuff I'll be lucky if I get five people
that have seen it. I mean, genuinely. So that
algorithm again, and that's probably less about
my skin color and more about forcing me to pay
for people to see the page. But it's, you know,
it's again. It is sometimes because I, yeah,
like there's another podcast I follow where they
were talking about that on Twitter. shadow banned
that's the tool that's the term for that um they
used to have like everything would be retweeted
a whole bunch and then they they said something
and then like now no one no one sees what they
they write anymore um and they pay in part because
they were like because they're like they were
shadow banned um but there's still like a level
that those companies are able to have some say
yeah yeah exactly well going back to you know
your point we're making with with redlining This
is another thing I just finished writing a book
the very end of last year, and I'm going to make
it into a show. But that multi -generational
trauma, you know, whether it is autoimmune disease,
whether it's cancer, I mean, it's stress that's
passed on from generation to generation. And
then hearing about all the things that you've
talked about today, the impact of stress, especially
chronically from a young child all the way through
to 40s, 50s, you know, you don't have to be a
genius. Then you add on environmental stress.
And obviously, you know, if you're growing up
in a place where you're not, Your environment
didn't allow you to understand movement and understand
what good food looks like. And then, you know,
we wonder why we have not only obesity and heart
disease, but also the cancers. So, I mean, you
know, again, going back to that proactive conversation,
the more we unpack all this, the more we get
to the, you know, the root causes again. And
I would argue a lot of the science is going to
show, well, hey, if we lived like we did 100
plus years ago, we're going to eliminate 80 %
of, you know, diseases by that point. Yeah. All
right. Well, the first of the closing questions,
is there a book or are there books that you'd
love to recommend? It can be related to our discussion
today or completely unrelated. No, I am not good
with like book recommendations at all. No, I'm
trying to, again, I'm between like trying to
write grants and all of that. I'm, I'm trying
to increase my writing, my reading, but when
I choose like a book, I, um, yeah, it's gonna,
it's, it's more like fantastical. So I'm like
right now reading a book, um, on Walt Disney.
Uh, so yeah, not related to research at all,
but it's been, yeah. So it's fun to be something
completely different. So yeah, no, I'm not good
with book recommendations. What about, um, films
or documentaries then? Uh, no, I'm not good at
that either. Yeah. It's interesting when people,
um, When they're curious, like if they're interested
in sleep, like I will point them to, I think
like the American Academy of Sleep Medicine has
started to build a very nice repository, a podcast.
And they're all like researchers that I don't
necessarily personally know, but I know their
work and their body of research. And I know it's
like good stuff. So I often point to that. And
then at one point, at least like the NIH had,
so they. within the national institute of heart
and blood lung diseases um they have like a sleep
repository or sleep center and so they have a
lot of great resources on there that i will also
point people to including like on youtube they'll
have um talks that have been given by different
sleep researchers uh as well as um they have
like um a couple of like There are like PDF books
you could print out or like sleep chapters that
give a nice overview on sleep health. So, yeah,
that's I think people ask those are usually the
places I point them to. Perfect. All right. Well,
the next question, speaking of people, is there
a person that you'd recommend to come on this
podcast as a guest to speak to the first responders,
military and associated professions of the world?
Well, you've already spoke to Joel and Sarah.
So those are the people that I would probably
point to. You know, I think, so I have a colleague
here, Leslie Hammer. I'm curious if she'd be
interested in speaking, but she comes at it.
She's worked with the National Guard and she
does a lot of research on like supervisor support
and including sleep support. So still like first
responder in nature, but not firefighters specifically.
But yeah, she comes very much from a supervisor
support and the importance there. And also she
also, so I. Because we're a NIOSH -funded center,
we lean in on their total worker health approach.
So that's another way of really noting a multi
-level approach. So recognizing that if you can
create change on the organizational level, you'll
have the largest impact. But there's also a role
for environmental changes in engineering and
personal level, whether that's thinking about
just PPE, which is important, but that's only
impacting one person. And then also like behavioral
change as well. So yeah, I think she could actually
be interesting and just from a slightly different
point of view. Brilliant. Well, thank you. All
right. Well, the very last question before we
make sure everyone knows where to find you, what
do you do to decompress? A lot of those hour
long walks I was talking about during the day.
So yeah, if I'm ever like at a, and I might break
those up in like 15 minute walks. So if I am
ever at a point where I'm like, you know, I've
been staring at a screen and I'm, you know i'm
not like actually paying attention to the words
that i'm reading or i'm not able to write like
i will just get up and i will go for a walk i
love spin classes um because especially well
it has to have good music but not all teachers
do but when it's a good class like i am completely
able to detach because i can just listen to the
music and and go fast um and then i mean the
summers out here in the pacific northwest are
just amazing and so every weekend we're if the
weather's if it's warm enough we're on the water
you know kayaking or paddle boarding um and then
my kids are just the best on the sand as well
because it's like a babysitter they can just
like build all day long and they're happy um
or we're picking fruit like i just did not realize
how many kinds of blackberries there were when
i moved out here like there's tea berries and
marion berries and um and then there's like a
cherry season and so we have all the things so
yeah i love to go fruit picking out here in the
summer as well beautiful all right well if people
do want to reach out learn more about you where
are the best places online um so you can email
our um our you can either email me personally
at bowls my last name n as a nicole at ohsu .edu
um or our lab account which is circadian um at
ohsu .edu Brilliant. Well, I want to thank you
so much. I mean, this is, it's always a different
perspective because you're coming from a research
lens, you know, and then obviously I'm talking
about being inside the bunker gear, but all these
layers are just so important to tell the whole
story. And some of the things that you've already
researched, some of the things that you're proposing
to research, especially the THC, for example,
has been so, so valuable for everyone to hear.
So I want to thank you so, so much for being
so generous with your time and coming on the
Behind the Shield podcast today. Thank you. Thanks
for having me. I think it's so important to get
outside of the walls of academia. One, to share
the knowledge that we've generated with American
taxpayer dollars. But because I learned so much
by talking to people who are not in these walls.
So thank you so much for having me.