WEBVTT

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This episode is sponsored by TeamBuildr, yet

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another company that's doing great things for

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things is obviously it tracks. To me, it's imperative

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that we as a profession start tracking our people

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from day one and then over the full span of their

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features. And if you want to take a deeper dive

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into Team Builder, listen to episode 1032 with

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Melissa Mercado or go to teambuildr .com. And

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I'll spell that to you because it's not as you

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think, T -E -A -M -B -U -I -L -D -R .com. Welcome

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to the Behind the Shield podcast. As always,

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my name is James Geering and this week it is

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my absolute honor to welcome on the show, researcher

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and associate professor, Dr. Nicole Bowles. Now

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in this conversation, we discuss a host of topics

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from the firefighter shift schedule, the 1323,

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the chronic and acute implications of sleep deprivation,

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cannabis and sleep, stress mitigation, health

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care, and so much more. Now, before we get to

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this incredible conversation, as I say every

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week, please just take a moment. Go to whichever

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app you listen to this on, subscribe to the show,

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leave feedback, and leave a rating. Every single

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five -star rating truly does elevate this podcast,

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therefore making it easier for others to find.

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And this is a free library of over 1 ,100 episodes

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now. So all I ask in return is that you help

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share these incredible men and women's stories

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so I can get them to every single person on planet

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Earth who needs to hear them. So with that being

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said, I introduce to you Dr. Nicole Bowles. Enjoy.

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Well, Nicole, I want to start by saying two things.

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Firstly, thank you to our mutual friend, Steve

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Sakaguchi, for making this connection. And secondly,

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I want to welcome you onto the Behind the Shield

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podcast today. Thanks, James. Thanks for having

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me. So where on planet Earth are we finding you

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this morning? Oh, that's great. I'm in Portland,

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Oregon, on the top of the hill where OHSU stands.

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Beautiful. Well, I would love to start at the

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very beginning of your timeline before we get

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into what you're doing currently. So tell me

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where you were born and tell me a little bit

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about your family dynamic, what your parents

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did, how many siblings. Oh, that's okay. We're

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going way back. Way back. Yeah. So I'm originally

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from Philadelphia, born and raised Chestnut Hill

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specifically. And yeah, my parents were... young

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when they had me um my mom worked at like a pharmacy

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um and then she went she ended up going more

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like an insurance um sales but um just like like

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customer service level. And then later in her

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life, went back and went to college and graduated

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right as I started grad school, actually. And

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then my father had multiple sclerosis. So he

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was in and out. He had just recently got diagnosed

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when I was born, but the symptoms were starting.

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And so fatigue was heavy. And so he worked in

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construction for a little bit. And then some

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customer service, but ended up on disability.

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And so for most of my years, I mostly just remember

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him in a wheelchair and his health declined over

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my life. And he ended up dying or passing away

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when I was a senior in high school. And my mom

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actually, she had type one diabetes, which was

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diagnosed shortly after I was born. So just having

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two autoimmune diseases and more broadly, my

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my grandmother, my dad's mom's side of the family,

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there's quite a lot of autoimmune diseases. So

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a couple of people have lupus and some lesser

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common conditions. And so that's what really

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got me interested in doing research. So that

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was my initial drive when I was thinking about.

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what I wanted to major in um in college um and

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then my parents got divorced when I was quite

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young when I was two um and yeah so and so I

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I spent most of my time with my mom and then

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I would see my dad every other weekend who ended

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up living with my grandmother because of his

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um condition and so I was always really really

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close to my grandmother who was um a or not college.

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She was second grade. That's not right. Fourth

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grade. Yeah. Fourth grade. She did some fifth

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grade teaching in Kensington, Philadelphia. So

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if anyone's aware of Kensington, I think it's

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probably more popular now because of so many

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videos that have show the drug use in that area,

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but always a low income area. And so I would

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always. go once or twice a year to help her set

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up her classroom. And towards the end, because

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my school always got out before her school did

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and to spend a day or so I'm with her in the

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teaching room. And so, yeah, I don't know. I

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guess I'll just say, I just, I've had, I, uh,

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I've seen, I've seen various, um, uh, I don't

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know, circumstances from my, from my own to,

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um, yeah, those were quite low. I remember she

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one of the times because someone didn't come

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to school towards the last day and I remember

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her actually like walking over to that parent's

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house and so I got to see what again like well

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a lot of the videos are out there now it wasn't

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nearly as bad back then but but still some pretty

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impoverished areas in homes so Yeah, I don't

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know. I guess those are the things that I'm thinking

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of when I think about like my early childhood.

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I ended up moving away from Philadelphia and

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into the suburbs when I was fifth grade. And

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I honestly think that like changed probably the

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trajectory that I went into the schools, what's

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available at those schools compared to the Philadelphia

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schools. seeing the materials that my grandmother

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had versus what i was able to get in the suburbs

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and like having ap classes available to me having

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i took photography in high school for two different

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years there was like interior design classes

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just the amount of things that were available

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and the resources that were available i'm not

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honestly sure if i would have went to college

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if i hadn't moved to the suburbs and maybe had

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some of those influences around me because It's,

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I think, me and my one older cousin among my

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dad's side of the family who were the only ones

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who have still gone on to college. And then my

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grandmother herself, who was also somebody who

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went back to school after she had her four kids.

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It's, again, similar to my mom. So, yeah, I don't

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know. Those are the things I think about when

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I think about my childhood. Interesting. There's

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so many things I kind of want to just... unpack

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for a moment firstly kensington i had a photographer

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suzanne stein and we're talking about current

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day kensington and the tranq epidemic that's

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just just ravaging that community you have a

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kind of interesting perspective though in the

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conversations with your grandmother did she ever

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talk about some of the systemic issues that were

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creating such desperation in some of these communities

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yeah it was like a circle of circumstances right

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i mean i remember one time she told me she found

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out one of her fourth graders was pregnant right

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and so um i mean i can't imagine right being

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nine and and then being you're becoming adult

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essentially at nine or if you want to i don't

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even know you're not an adult you're just a child

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raising a child so there's just a lot of poverty

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and it's how really it is hard to get out of

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those circumstances and in some Often because

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of the stress you have and you don't feel like

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there's any other way you do turn to drugs. And

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so, yeah, there's a circle of that. I do remember

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some of her students who made it out and they

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would run into her in the mall. We would see

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somebody and just like how proud they were to

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be able to tell her that they were able to make

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it out. And, you know, the role that she played

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in that she. As a teacher in that school, I remember

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not only interacting with her students, but then

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the other teachers and the principals. And they

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could always give what was considered like the

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troubled kids to her because she was always able

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to like nurture them. And so and they they they

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just acted different. Like she could just say

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their name and they would they would stop whatever

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they were doing in the recess. And it was because

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they had like a respect for her, but also because

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she didn't treat them differently. maybe even

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gave them like extra attention and warmth and

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um yeah so i remember those same kids like coming

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up to me when they were in fourth grade saying

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how much they like loved my grandmother and how

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lucky i was um so maybe it was just like their

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ability to have that that sheltered time that

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protected time um like on the other side i remember

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also there was one time where like um child child

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protective services had to come to her classroom

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because a kid had had like indications of like

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being strangled. So yeah, I mean, there's just,

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you know, abuse and those, the trauma that leaves,

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unfortunately, if it's not dealt with, it comes

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back up. And so there's just a circle of it and

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it makes it really hard to get out of those circumstances.

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I interviewed a Finnish educator who actually

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moved to Australia. Now he tours the world talking

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about the Finland education system. And I'll

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never forget this. He talked about they invest

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more in the schools that are more challenged,

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whether it's poverty or whatever the barrier

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is to those kids kind of being elevated. The

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Finnish government invests more money in those

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areas. And then you look at the way the American

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system is, you know, if you're not performing

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air quotes as a school, then you lose support,

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you lose funding. So it's such a backward, you

00:11:52.559 --> 00:11:55.419
know, philosophy and you've educated it perfectly.

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Same exact person. You were in one environment

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and you reflect back now and like, what have

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I even gone to college? You simply moved to a

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different postcode and the environment was completely

00:12:05.620 --> 00:12:09.580
different. Exactly. Absolutely. Well, then also

00:12:09.580 --> 00:12:13.120
with this autoimmune history that you have, we're

00:12:13.120 --> 00:12:16.379
kind of jumping ahead. But in this research path

00:12:16.379 --> 00:12:20.220
that you've got, have you found any common denominators

00:12:20.220 --> 00:12:22.639
to some of the underlying causes of autoimmune

00:12:22.639 --> 00:12:25.600
disease, especially in modern society? Yeah,

00:12:25.620 --> 00:12:28.320
no. So that's originally when I was like applying

00:12:28.320 --> 00:12:30.700
to grad schools. That was my intention to study

00:12:30.700 --> 00:12:34.960
that. But at the time I was I was. thinking about

00:12:34.960 --> 00:12:37.779
what program I wanted to go into, I was thinking

00:12:37.779 --> 00:12:39.700
about like, what are the causes, right? I think

00:12:39.700 --> 00:12:42.620
again about like my mother's upbringing and my

00:12:42.620 --> 00:12:45.440
father's upbringing and my other relatives, like

00:12:45.440 --> 00:12:47.840
what, what was it about their environment that,

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you know, suddenly like we have so much. And

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so part of it, I'm like, okay, there's, there's

00:12:52.559 --> 00:12:55.539
likely a genetic, but it's not coming on everybody.

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So what, what is it? And so I, that's how I got

00:12:58.600 --> 00:13:00.460
interested in more like, I don't say I'm not

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environmental researcher, but I study. exposure

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to light and so that's how i got interested in

00:13:05.740 --> 00:13:07.740
just like what are the impacts of our environment

00:13:07.740 --> 00:13:11.659
on health and part but also stress like that's

00:13:11.659 --> 00:13:14.759
as i was actually writing my applications and

00:13:14.759 --> 00:13:16.139
really thinking about what i wanted to study

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like stress just just continued to come up in

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my mind like how people are able to perceive

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the straps how they're able to cope with it and

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how does that um translate to our health and

00:13:27.519 --> 00:13:30.779
so I ended up going in that direction. So I never

00:13:30.779 --> 00:13:33.159
came back around to autoimmune diseases, but

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I do now study like those environmental exposures,

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those stress exposures, and think about how they

00:13:38.360 --> 00:13:42.440
are impacting stress or impacting health. And

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who knows, like maybe one day I'll still come

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back to the autoimmune side of it. My whole philosophy

00:13:48.120 --> 00:13:51.080
is I go back to the fact that I truly believe

00:13:51.080 --> 00:13:54.320
that the creation of the human being through

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all these kind of survival of the fittest generations,

00:13:58.859 --> 00:14:01.940
has an innate ability to heal has an innate ability

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to thrive and of course we all know that there

00:14:04.120 --> 00:14:06.500
are anomalies but in you know generally i think

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that's the case so then if you look at that and

00:14:09.220 --> 00:14:11.440
all these people that for example suffer immune

00:14:11.440 --> 00:14:14.620
you know autoimmune disease yes there's a maybe

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a genetic i want to use the word weakness that

00:14:17.559 --> 00:14:21.429
sounds kind of um you know a judgmental word,

00:14:21.570 --> 00:14:23.909
if you like, but, you know, a tendency maybe

00:14:23.909 --> 00:14:26.309
to get some of these diseases over other people.

00:14:26.389 --> 00:14:28.529
But what, you know, what are those factors? Because

00:14:28.529 --> 00:14:30.350
I truly believe like, you know, for example,

00:14:30.350 --> 00:14:32.710
not everyone is supposed to be obese. We know

00:14:32.710 --> 00:14:35.509
the external factors, the sleep factors that

00:14:35.509 --> 00:14:38.629
contribute to that. So, you know, once we can

00:14:38.629 --> 00:14:40.649
really take a step back and start identifying

00:14:40.649 --> 00:14:43.850
the contributing factors to these diseases, we

00:14:43.850 --> 00:14:46.470
can at least have some power over them versus

00:14:46.470 --> 00:14:48.509
if we just shrug our shoulders and say the word

00:14:48.509 --> 00:14:50.840
genetic. I feel like we're missing a big part

00:14:50.840 --> 00:14:54.879
of the puzzle then. Yes, I agree. As I was thinking

00:14:54.879 --> 00:14:59.419
about that, my mom, so my mom was adopted and

00:14:59.419 --> 00:15:04.279
she was like cleaning out. records that she had

00:15:04.279 --> 00:15:07.940
from her mom like her adoptive mom she found

00:15:07.940 --> 00:15:10.379
some records from the foster home that she was

00:15:10.379 --> 00:15:14.259
in for a brief amount of time and back then I

00:15:14.259 --> 00:15:16.860
guess there wasn't formula in my mind like formula

00:15:16.860 --> 00:15:19.620
has been around for a long time but then yeah

00:15:19.620 --> 00:15:22.159
so how do you then feed a newborn and so they

00:15:22.159 --> 00:15:26.159
had like this regimen of mixing like I don't

00:15:26.159 --> 00:15:29.299
I I can't remember exactly. I wanted to say milk,

00:15:29.299 --> 00:15:31.039
but maybe they knew enough that they couldn't

00:15:31.039 --> 00:15:33.840
give cows milk, but there was juice. They were

00:15:33.840 --> 00:15:36.440
giving a baby juice. It was like, give this much

00:15:36.440 --> 00:15:38.600
apple juice and give this much. And then it's

00:15:38.600 --> 00:15:41.360
like, okay, are we maybe surprised she became

00:15:41.360 --> 00:15:44.799
diabetic if she was just getting basically pure

00:15:44.799 --> 00:15:49.019
sugar as a newborn? I mean, she was able to grow

00:15:49.019 --> 00:15:53.179
and reach heightened milestones and whatnot,

00:15:53.320 --> 00:15:56.070
but perhaps not then surprising that. later in

00:15:56.070 --> 00:16:00.730
life, she wasn't able to process sugar. Absolutely.

00:16:01.070 --> 00:16:03.549
I mean, for example, ALS, you know, there are

00:16:03.549 --> 00:16:05.769
a lot of people that do combat sports and football

00:16:05.769 --> 00:16:09.570
that don't get ALS, but it seems to be a common

00:16:09.570 --> 00:16:12.090
denominator in the people that do is some sort

00:16:12.090 --> 00:16:14.529
of head trauma. So again, just because everyone

00:16:14.529 --> 00:16:16.309
doesn't get it doesn't mean that you ignore some

00:16:16.309 --> 00:16:20.139
of the contributing factors. So what about the

00:16:20.139 --> 00:16:22.460
research journey, then you kind of, you know,

00:16:22.460 --> 00:16:24.240
you're looking into the stress world now, was

00:16:24.240 --> 00:16:27.740
that immediately sleep medicine? Or did it kind

00:16:27.740 --> 00:16:51.220
of start somewhere else? glucocorticoids, so,

00:16:51.220 --> 00:16:53.820
you know, cortisol in humans, corticosterone

00:16:53.820 --> 00:16:57.659
in rodents, and looking at mechanisms and how

00:16:57.659 --> 00:17:01.559
that was impacting metabolism. And then towards

00:17:01.559 --> 00:17:05.279
the end, looking at just natural ways to potentially

00:17:05.279 --> 00:17:09.359
alter corticosterone. Again, I was working in

00:17:09.359 --> 00:17:12.819
rodents. And that was through changing lighting

00:17:12.819 --> 00:17:17.309
regimens. So instead of... we generally have

00:17:17.309 --> 00:17:20.150
12 hours of light, 12 hours of dark, we would

00:17:20.150 --> 00:17:22.509
manipulate that. So they had a 20 -hour day with

00:17:22.509 --> 00:17:26.269
10 hours of light and 10 hours of dark. And that

00:17:26.269 --> 00:17:31.490
drastically impacted their regular corticosterone

00:17:31.490 --> 00:17:36.109
response. And so it was that, in part, that got

00:17:36.109 --> 00:17:39.789
me more into sleep and circadian research. But

00:17:39.789 --> 00:17:41.710
I was also interested in perceptions of stress,

00:17:41.730 --> 00:17:45.660
as I just mentioned. Even while I was in grad

00:17:45.660 --> 00:17:48.559
school, part of the reason I went to Rockefeller,

00:17:48.619 --> 00:17:50.380
they have a very unique program where you can

00:17:50.380 --> 00:17:52.880
basically pick the courses you want relevant

00:17:52.880 --> 00:17:56.900
to the actual research you're doing. And so I

00:17:56.900 --> 00:17:59.700
even at that time knew I wanted to pair like

00:17:59.700 --> 00:18:02.339
basic science research with public health. And

00:18:02.339 --> 00:18:05.559
so I took courses at Columbia's School of Public

00:18:05.559 --> 00:18:09.220
Health and I went to University of Michigan and

00:18:09.220 --> 00:18:13.930
took some of their courses. And again, I was

00:18:13.930 --> 00:18:16.630
thinking like, okay, mice, I can't measure how

00:18:16.630 --> 00:18:19.210
they're perceiving what we're doing. If we're

00:18:19.210 --> 00:18:20.869
changing their lighting, if we're restraining

00:18:20.869 --> 00:18:23.990
them, like I'm not capturing fully what I want

00:18:23.990 --> 00:18:26.369
it to. And so I ended up going and getting a

00:18:26.369 --> 00:18:29.130
degree in clinical epidemiology from Weill Cornell,

00:18:29.349 --> 00:18:34.250
which is Cornell's medical college. And further.

00:18:36.140 --> 00:18:39.279
going into my circadian research trying to translate

00:18:39.279 --> 00:18:42.359
what i found in rodents into humans and also

00:18:42.359 --> 00:18:44.720
just like learning how to run epidemiological

00:18:44.720 --> 00:18:48.940
studies and qualitative studies so not just getting

00:18:48.940 --> 00:18:52.960
um getting surveys or running blood panel tests

00:18:52.960 --> 00:18:55.839
but actually meeting people where they were and

00:18:55.839 --> 00:18:59.920
understanding um in a more just conversational

00:18:59.920 --> 00:19:03.900
way what they're experiencing which has been

00:19:03.900 --> 00:19:09.609
a great tool um that i've used um for ever since

00:19:09.609 --> 00:19:11.589
then for research and engaging with different

00:19:11.589 --> 00:19:16.329
populations um but yeah so what that's really

00:19:16.329 --> 00:19:18.390
when i got into the sleep in circadian and i

00:19:18.390 --> 00:19:21.009
worked with new york city transit workers and

00:19:21.009 --> 00:19:23.970
um saw that again it's clearly it's not just

00:19:23.970 --> 00:19:26.150
the hours that they're working right but it's

00:19:26.150 --> 00:19:29.369
it was so many other factors look just like Based

00:19:29.369 --> 00:19:31.309
on the hours they're working, what kind of food

00:19:31.309 --> 00:19:33.490
is available to them, especially if they're a

00:19:33.490 --> 00:19:35.769
conductor in a train and there's only certain

00:19:35.769 --> 00:19:37.569
places they can go to the bathroom and where

00:19:37.569 --> 00:19:40.890
they can eat. That dictates the choices and when

00:19:40.890 --> 00:19:44.609
they're going to drink something to hydrate themselves

00:19:44.609 --> 00:19:46.769
and the kind of foods that they're available.

00:19:47.309 --> 00:19:49.390
Also, because there's not even a refrigerator.

00:19:49.529 --> 00:19:51.990
So even if they bring food with them, how can

00:19:51.990 --> 00:19:58.900
they keep it in safe conditions? also just opened

00:19:58.900 --> 00:20:02.240
my eyes to that it's yes scheduling and things

00:20:02.240 --> 00:20:05.099
like that are part of the issue but um it was

00:20:05.099 --> 00:20:10.019
a much it's multi um level you mentioned the

00:20:10.019 --> 00:20:12.240
rat study what were the findings what was the

00:20:12.240 --> 00:20:14.859
impact on cortisol or the vat version of cortisol

00:20:14.859 --> 00:20:17.799
with changing the uh the day their perceived

00:20:17.799 --> 00:20:22.190
day yeah it flattened it out So there's some

00:20:22.190 --> 00:20:24.730
research that shows that glucocorticoids are

00:20:24.730 --> 00:20:29.569
important for connecting the clock in the brain,

00:20:29.890 --> 00:20:33.569
the master clock, which is largely driven by

00:20:33.569 --> 00:20:36.230
light response. And then cortisol is able to

00:20:36.230 --> 00:20:38.250
connect that in the periphery. And we saw that

00:20:38.250 --> 00:20:41.049
when you alter the lighting and they're not able

00:20:41.049 --> 00:20:43.630
to entrain to the new day, their cortisol rhythm

00:20:43.630 --> 00:20:46.829
is flattened. And then those animals end up gaining

00:20:46.829 --> 00:20:49.880
like a metabolic syndrome. like phenotype. So

00:20:49.880 --> 00:20:53.359
higher triglycerides, higher, I'm trying to remember

00:20:53.359 --> 00:20:56.519
what we measured, but like a pre -diabetic state,

00:20:56.900 --> 00:20:59.779
increased weight gain, things like that. Sounds

00:20:59.779 --> 00:21:04.180
like the fire service. Interesting. Have you

00:21:04.180 --> 00:21:06.759
come across the work of Professor Russell Foster?

00:21:08.259 --> 00:21:10.900
Not by name. I might be aware of the work, but

00:21:10.900 --> 00:21:12.779
I don't recall the name. It's really interesting

00:21:12.779 --> 00:21:15.180
because he actually was the man who discovered

00:21:15.180 --> 00:21:19.440
the chronoreceptor in the eye. So he's the neuroscientist,

00:21:19.500 --> 00:21:23.059
went to the ophthalmology world, and they had

00:21:23.059 --> 00:21:25.039
rods and cones. And he was like, look, there's

00:21:25.039 --> 00:21:27.660
something else. And he was talking about the

00:21:27.660 --> 00:21:31.599
chronobiology of this, the circadian rhythm.

00:21:31.799 --> 00:21:35.740
And he was literally laughed out of many a hall,

00:21:35.920 --> 00:21:38.839
many a conference talking about this. And he

00:21:38.839 --> 00:21:41.220
was ultimately able to prove it. And so it's

00:21:41.220 --> 00:21:43.019
really interesting because he is the pioneer

00:21:43.019 --> 00:21:45.200
of this. And yet you never hear him discuss.

00:21:45.359 --> 00:21:47.720
So I try and put his name out there. But phenomenal.

00:21:47.819 --> 00:21:50.079
He's got a book called Lifetime. He's actually

00:21:50.079 --> 00:21:52.119
he's been on the show. He's coming back on in

00:21:52.119 --> 00:21:54.539
a few weeks again. But if you haven't looked

00:21:54.539 --> 00:21:56.539
at his work, I mean, probably a lot of the work

00:21:56.539 --> 00:21:58.819
that you're actually looking into originated

00:21:58.819 --> 00:22:02.960
from from his lab in Oxford. But yeah, so then

00:22:02.960 --> 00:22:05.339
so let's kind of move forward then. So you now

00:22:05.339 --> 00:22:09.049
look trying to look at the human side. you're

00:22:09.049 --> 00:22:10.910
working with the transit authority specifically

00:22:10.910 --> 00:22:14.430
what was the next step as far as the impact of

00:22:14.430 --> 00:22:18.789
these different shifts on the human now yeah

00:22:18.789 --> 00:22:22.049
so i still wanted to because look at my basic

00:22:22.049 --> 00:22:23.549
training i was still interested in more mechanisms

00:22:23.549 --> 00:22:26.460
and studying just purely going straight into

00:22:26.460 --> 00:22:28.039
the field i wasn't going to be able to answer

00:22:28.039 --> 00:22:31.319
those questions either so i ended up coming to

00:22:31.319 --> 00:22:34.119
that's when i came to portland to work with stephen

00:22:34.119 --> 00:22:37.059
shea at the oregon institute of occupational

00:22:37.059 --> 00:22:41.940
health sciences who runs human studies under

00:22:41.940 --> 00:22:45.299
highly controlled conditions and so we can manipulate

00:22:45.299 --> 00:22:48.619
just like i do for i did for the mice i can change

00:22:48.619 --> 00:22:50.559
their lighting schedules and their day duration

00:22:50.559 --> 00:22:55.069
and we can tease apart using math models what

00:22:55.069 --> 00:22:57.109
are the contributions of the circadian system

00:22:57.109 --> 00:22:59.789
versus what are the contributions of behaviors,

00:23:00.170 --> 00:23:06.230
sleep, you know, eating or diet. And so, yeah,

00:23:06.250 --> 00:23:08.089
so then, so they ended up coming out here to

00:23:08.089 --> 00:23:13.369
do that. So what, what were some of the findings

00:23:13.369 --> 00:23:15.650
that surprised you when you started diving into

00:23:15.650 --> 00:23:17.690
that area, as far as the impact of the human

00:23:17.690 --> 00:23:21.069
body on some of these shifts and changes in work

00:23:21.069 --> 00:23:26.880
environments? So yeah, we can study the underlying

00:23:26.880 --> 00:23:30.819
condition or the biology, which is important,

00:23:31.019 --> 00:23:33.099
especially for drug development and things like

00:23:33.099 --> 00:23:37.960
that. So it's nice to have that perspective when

00:23:37.960 --> 00:23:41.710
then going into the field because we can... understand

00:23:41.710 --> 00:23:44.369
like that's how we understand that there's the

00:23:44.369 --> 00:23:46.730
two process model for sleep and you're you have

00:23:46.730 --> 00:23:48.849
a circadian system that drives alertness and

00:23:48.849 --> 00:23:50.970
then you have the sleep homeostatic process which

00:23:50.970 --> 00:23:53.369
the longer you're awake the more tired you are

00:23:53.369 --> 00:23:55.710
right so it's nice to have to be able to study

00:23:55.710 --> 00:23:57.589
that and you can only do that under controlled

00:23:57.589 --> 00:24:00.890
conditions what makes it hard in translation

00:24:00.890 --> 00:24:03.650
is that you can give an ideal schedule but then

00:24:03.650 --> 00:24:07.009
you meet real life and that's um you know having

00:24:07.009 --> 00:24:09.710
social needs when you're off that's going to

00:24:09.710 --> 00:24:12.170
prevent you from maybe sleeping at the ideal

00:24:12.170 --> 00:24:14.289
time right we can come up with a schedule that

00:24:14.289 --> 00:24:17.069
says if you're awoken this much while you're

00:24:17.069 --> 00:24:19.869
on shift you can you need to get this much recovery

00:24:19.869 --> 00:24:21.990
sleep in this amount of time which i should the

00:24:21.990 --> 00:24:23.970
science not isn't necessarily there yet either

00:24:23.970 --> 00:24:28.240
but let's say we could get there You also just

00:24:28.240 --> 00:24:32.059
meet reality, right? And so that's been the great

00:24:32.059 --> 00:24:35.940
thing about working in the field. But it's also

00:24:35.940 --> 00:24:37.619
the biggest challenge because then you have multiple

00:24:37.619 --> 00:24:41.259
levels that you have to develop interventions

00:24:41.259 --> 00:24:43.519
for. And then you also have to learn how to implement

00:24:43.519 --> 00:24:46.180
those interventions. And so that is where we

00:24:46.180 --> 00:24:48.759
are now. And that is the challenge. I mean, then

00:24:48.759 --> 00:24:50.259
you also have things like budget, right? Like

00:24:50.259 --> 00:24:53.319
what are the budget requirements and the culture

00:24:53.319 --> 00:24:56.400
of the particular... Think about firefighters,

00:24:56.539 --> 00:25:00.980
the culture of the particular department, right?

00:25:01.079 --> 00:25:04.660
That we have in Oregon, there's a lot of the

00:25:04.660 --> 00:25:07.319
departments have individual sleeping quarters.

00:25:07.480 --> 00:25:09.680
And so that is what the culture is there, right?

00:25:09.740 --> 00:25:12.380
But I'll speak to somebody in a different part

00:25:12.380 --> 00:25:14.839
of the world where it's like, well, not only

00:25:14.839 --> 00:25:17.099
the chief should have individual sleeping rooms,

00:25:17.140 --> 00:25:18.920
everyone else should be in a dorm room, right?

00:25:19.720 --> 00:25:21.900
Regardless of the fact that maybe someone has

00:25:21.900 --> 00:25:24.079
sleep apnea and is snoring and is keeping everybody

00:25:24.079 --> 00:25:27.160
else awake, it doesn't matter because that's

00:25:27.160 --> 00:25:29.819
what is expected in our department. So there's

00:25:29.819 --> 00:25:34.099
just a lot more things that, okay, yeah, there

00:25:34.099 --> 00:25:35.720
is the underlying science, but then you also

00:25:35.720 --> 00:25:39.859
just have the actual, you have the psychology

00:25:39.859 --> 00:25:44.420
of individuals and the sociology of the larger

00:25:44.420 --> 00:25:47.920
group. With some of the sleep studies that have

00:25:47.920 --> 00:25:51.380
been done, I'm thinking about an actual study

00:25:51.380 --> 00:25:54.920
in a lab versus putting wearables on a firefighter,

00:25:54.920 --> 00:25:59.000
for example. What does that kind of look like

00:25:59.000 --> 00:26:01.200
as far as a landscape? Are they usually students

00:26:01.200 --> 00:26:05.480
of that college? Who's running the projects?

00:26:05.779 --> 00:26:10.400
No, that would be the actual recipients. Of the

00:26:10.400 --> 00:26:13.819
outcomes of an in -lab study? Yes. Let me put

00:26:13.819 --> 00:26:16.410
it. in a better way. So, so the people that you

00:26:16.410 --> 00:26:19.369
are going to study in a clinical setting in a

00:26:19.369 --> 00:26:22.950
sleep study, for example, at a university with

00:26:22.950 --> 00:26:25.670
those people tend to be college students, those

00:26:25.670 --> 00:26:27.829
kinds of people. Okay. Yeah. So, yeah, I mean,

00:26:27.829 --> 00:26:31.069
so that's, and that's where, yeah. Um, so yeah,

00:26:31.130 --> 00:26:33.329
I mean, generally that has been what it is. Right.

00:26:33.390 --> 00:26:35.690
And like most of the studies that have been out

00:26:35.690 --> 00:26:39.089
there have been, uh, young males. Right. And

00:26:39.089 --> 00:26:41.599
so then there was, A couple groups that, you

00:26:41.599 --> 00:26:43.519
know, have made the efforts to make sure, and

00:26:43.519 --> 00:26:47.740
then now because NIH requires having, unless

00:26:47.740 --> 00:26:49.980
you have a strong rationale for not, of having

00:26:49.980 --> 00:26:52.980
males and females in studies. Unfortunately,

00:26:53.059 --> 00:26:55.599
they haven't given more money to increase your

00:26:55.599 --> 00:26:59.680
N, and so studies are still not necessarily powered

00:26:59.680 --> 00:27:04.220
to look at sex differences, but now they are,

00:27:04.359 --> 00:27:06.180
at least you can say there are males and females

00:27:06.180 --> 00:27:10.369
in a study. So there's that generalizability,

00:27:10.569 --> 00:27:14.910
but yeah, often still young. When I came out

00:27:14.910 --> 00:27:18.829
here and working with Dr. Shea, his interest

00:27:18.829 --> 00:27:21.130
was starting to look in sick populations, right?

00:27:21.150 --> 00:27:24.049
So he was one of the first to have one of these

00:27:24.049 --> 00:27:28.650
circadian studies in originally populations that

00:27:28.650 --> 00:27:32.930
had sleep apnea to see if the circadian system

00:27:32.930 --> 00:27:41.430
is impacting when you might have... And then

00:27:41.430 --> 00:27:44.750
we move to individuals that had hypertension

00:27:44.750 --> 00:27:47.430
or at least like this phenomenon called non -dipping

00:27:47.430 --> 00:27:49.450
where your blood pressure doesn't drop as much

00:27:49.450 --> 00:27:51.829
at night to again see how the circadian system

00:27:51.829 --> 00:27:55.710
and sleep and other behaviors are impacting that

00:27:55.710 --> 00:27:59.720
phenotype. And so moving in that direction, but

00:27:59.720 --> 00:28:01.980
it is often challenging because you're still

00:28:01.980 --> 00:28:04.940
trying to reduce the number of variables in a

00:28:04.940 --> 00:28:06.940
study. So, yes, now you want to study with someone

00:28:06.940 --> 00:28:10.160
with sleep apnea, but you want to make sure it's

00:28:10.160 --> 00:28:14.319
truly it's sleep apnea. Maybe it's not diabetes

00:28:14.319 --> 00:28:16.400
or something like that. So there's a lot of excluding

00:28:16.400 --> 00:28:19.359
criteria still because either you have two options,

00:28:19.460 --> 00:28:21.900
study lots and lots of people. So where you can

00:28:21.900 --> 00:28:28.119
then model and. adjust for those different variables,

00:28:28.240 --> 00:28:31.539
or you have a very clean group. Either it's hard

00:28:31.539 --> 00:28:33.740
because it's hard to get lots of people to have

00:28:33.740 --> 00:28:36.420
the ability to stay in a lab for seven days to

00:28:36.420 --> 00:28:39.220
run these kinds of studies. But it's also hard

00:28:39.220 --> 00:28:42.819
to find people who only have one disease or at

00:28:42.819 --> 00:28:45.799
least like a disease based on the things we're

00:28:45.799 --> 00:28:49.829
measuring for our exclusion criteria. but still

00:28:49.829 --> 00:28:52.730
like needed in order to like tease those things

00:28:52.730 --> 00:28:55.369
apart. So, I mean, those are the difficulties

00:28:55.369 --> 00:28:58.130
of the in -lab studies. That is often why a lot

00:28:58.130 --> 00:29:00.349
of studies have just done college students because

00:29:00.349 --> 00:29:03.670
they have the time, they need a little extra

00:29:03.670 --> 00:29:07.410
income. We have for our studies, so I've tried

00:29:07.410 --> 00:29:11.029
to also following my mentor's lead, make sure

00:29:11.029 --> 00:29:13.759
we have a more diverse group. that's part of

00:29:13.759 --> 00:29:16.700
my community work is getting out there taking

00:29:16.700 --> 00:29:21.200
the data back out to the community um in a conversational

00:29:21.200 --> 00:29:24.299
way where we're teaching them giving opportunities

00:29:24.299 --> 00:29:27.220
for them to ask questions to have some influence

00:29:27.220 --> 00:29:31.640
on our designs of our studies um to be like just

00:29:31.640 --> 00:29:34.839
to like break it down and what that could mean

00:29:34.839 --> 00:29:39.180
is Having movie selections, for example. So when

00:29:39.180 --> 00:29:41.420
they're not doing collection and they have time

00:29:41.420 --> 00:29:43.579
to watch a movie, making sure that the movie

00:29:43.579 --> 00:29:46.220
selection we have are things that people actually

00:29:46.220 --> 00:29:50.299
want to see. Maybe increasing the comfortability

00:29:50.299 --> 00:29:52.319
because it's just a hospital room. So putting

00:29:52.319 --> 00:29:56.619
pictures up or maybe having a satin pillowcase

00:29:56.619 --> 00:29:59.019
for individuals whose hair is more prone to drying

00:29:59.019 --> 00:30:01.680
out if they just have a cotton sheet. Things

00:30:01.680 --> 00:30:04.779
like that that make people maybe a little more...

00:30:05.689 --> 00:30:08.029
um, break down some of those barriers to being

00:30:08.029 --> 00:30:11.589
in a hospital for 70 is to do a study. Uh, so

00:30:11.589 --> 00:30:13.589
yeah, so we've, we've worked to try to make those

00:30:13.589 --> 00:30:16.609
studies more diverse, but it's, it's a challenge.

00:30:16.650 --> 00:30:18.349
Yeah. Just finding people who have the time and

00:30:18.349 --> 00:30:21.529
the ability to do that. One of my guests a while

00:30:21.529 --> 00:30:23.269
ago made a really interesting point that I'd

00:30:23.269 --> 00:30:25.869
never thought about before when, I mean, I've

00:30:25.869 --> 00:30:27.650
been doing this podcast now for eight and a half

00:30:27.650 --> 00:30:30.269
years and talking about shortening the work week

00:30:30.269 --> 00:30:32.210
for fire service. And we'll get to that of course,

00:30:32.210 --> 00:30:36.140
but I get told, well, show me the data. And my

00:30:36.140 --> 00:30:38.420
first kickback is, well, if you need a study

00:30:38.420 --> 00:30:40.420
to show that a 42 -hour workweek is healthier

00:30:40.420 --> 00:30:43.039
than a 56, then you're kind of missing the point

00:30:43.039 --> 00:30:45.900
of common sense as well. But that being said,

00:30:46.519 --> 00:30:49.779
his point was, well, imagine if they actually

00:30:49.779 --> 00:30:53.519
laid out a study, let's say a 30 -day study of

00:30:53.519 --> 00:30:55.599
what it would like to be a firefighter, and you

00:30:55.599 --> 00:30:59.619
did 24 on, 48 off, and then throw some 48 on,

00:30:59.660 --> 00:31:02.960
24 off when you get mandatory overtime. ethically,

00:31:03.059 --> 00:31:05.700
would a board even allow you to keep a bunch

00:31:05.700 --> 00:31:08.180
of college students up for 24 hours at a time

00:31:08.180 --> 00:31:11.460
every third day and add a 24 once or twice through

00:31:11.460 --> 00:31:14.480
that month? And he was saying that I don't think

00:31:14.480 --> 00:31:17.519
any ethics board would. So, and then please correct

00:31:17.519 --> 00:31:20.380
me if I'm wrong, but the irony was we're told,

00:31:20.480 --> 00:31:24.220
well, show us research when from his perspective,

00:31:24.319 --> 00:31:26.380
it's like, well, in that clinical settings, no

00:31:26.380 --> 00:31:29.339
one would actually allow you to even. put a human

00:31:29.339 --> 00:31:31.680
test subject through that even though our firefighters

00:31:31.680 --> 00:31:35.599
work those very schedules so yeah i think there's

00:31:35.599 --> 00:31:38.039
in the past there have been some amount of like

00:31:38.039 --> 00:31:41.359
sleep deprivation studies i think maybe even

00:31:41.359 --> 00:31:44.359
like up to like 36 hours um and repeated and

00:31:44.359 --> 00:31:46.380
so we've actually built some like modeling based

00:31:46.380 --> 00:31:49.319
on those kind of studies that's what i think

00:31:49.319 --> 00:31:51.480
it's getting more challenging to do that the

00:31:51.480 --> 00:31:56.119
irbs are putting up um yeah more restrictions

00:31:56.119 --> 00:31:59.690
so I would say like you had like one sleep deprivation

00:31:59.690 --> 00:32:01.930
of like 24 hours, you would be allowed to do

00:32:01.930 --> 00:32:03.990
that. I think you'd have to give a strong rationale

00:32:03.990 --> 00:32:06.869
of how often you could repeat that. I think there

00:32:06.869 --> 00:32:09.990
could be some level of it. I think honestly,

00:32:10.029 --> 00:32:12.029
right now, the bigger challenges is like the

00:32:12.029 --> 00:32:15.289
financing of those kind of studies. It's just

00:32:15.289 --> 00:32:20.250
not possible these days. There used to be, the

00:32:20.250 --> 00:32:24.910
NIH used to pay for shared services. And so when,

00:32:25.069 --> 00:32:27.930
like, again. Steve, actually, even when I first

00:32:27.930 --> 00:32:30.730
came here to OHSU, we could make use of research

00:32:30.730 --> 00:32:33.069
rooms for free. They weren't free. They were

00:32:33.069 --> 00:32:36.470
paid for by this shared resource. And the nursing

00:32:36.470 --> 00:32:38.869
cost was also covered. And so you could then

00:32:38.869 --> 00:32:40.769
you would just have to pay for the staff you

00:32:40.769 --> 00:32:45.190
need to run the study and the equipment and people

00:32:45.190 --> 00:32:47.410
for their time. And so that you could do with

00:32:47.410 --> 00:32:52.049
a NIH four or five year grant. Now we pay and

00:32:52.049 --> 00:32:54.069
the prices are going up every year. It's like.

00:32:55.190 --> 00:33:00.289
over $1 ,000 for rooms, $99 an hour for nursing

00:33:00.289 --> 00:33:02.450
time. So those are the things that I think are

00:33:02.450 --> 00:33:04.589
probably the more prohibitive things. I think

00:33:04.589 --> 00:33:07.369
if you made a good claim to a given IRB, you

00:33:07.369 --> 00:33:10.710
probably could do some amount of cycling and

00:33:10.710 --> 00:33:12.990
part because you could say, this is what people

00:33:12.990 --> 00:33:15.049
are actually experiencing and we are trying to

00:33:15.049 --> 00:33:17.490
understand what amount of sleep they actually

00:33:17.490 --> 00:33:20.089
need to recover after having these. Especially

00:33:20.089 --> 00:33:22.869
I think if you point to like the forest firefighters

00:33:22.869 --> 00:33:26.529
who were like during very tight seasons really

00:33:26.529 --> 00:33:28.490
are having large consecutive belts where they're

00:33:28.490 --> 00:33:30.450
not sleeping whether it's because they don't

00:33:30.450 --> 00:33:33.029
have the time because they're fighting or because

00:33:33.029 --> 00:33:35.589
then when they're supposed to be sleeping they're

00:33:35.589 --> 00:33:38.289
sleeping in hot tents if they're in the pacific

00:33:38.289 --> 00:33:41.490
northwest they have long days so like the time

00:33:41.490 --> 00:33:44.529
when it's actually dark is quite minimal um and

00:33:44.529 --> 00:33:46.430
so they're not in an environment where they can

00:33:46.430 --> 00:33:48.190
actually sleep so whether it's because they don't

00:33:48.190 --> 00:33:50.650
have the time to sleep or because they just actually

00:33:50.650 --> 00:33:54.700
can't sleep um It's happening, right? And so

00:33:54.700 --> 00:33:56.319
I think you could make a strong case for the

00:33:56.319 --> 00:33:59.240
need to run these kind of studies. But it's the

00:33:59.240 --> 00:34:01.339
cost, I think, that's preventing it right now.

00:34:01.720 --> 00:34:03.900
With these cuts that we're seeing at the moment,

00:34:03.980 --> 00:34:07.339
what impact are you seeing on the research when

00:34:07.339 --> 00:34:10.880
it comes to the fire service? Yeah, I mean, so

00:34:10.880 --> 00:34:13.800
my research right now with the fire service is

00:34:13.800 --> 00:34:18.039
funded through NIOSH. And that is a department

00:34:18.039 --> 00:34:21.639
that has been gutted, right? enough people there

00:34:21.639 --> 00:34:23.639
to make the argument that they haven't gotten

00:34:23.639 --> 00:34:26.639
rid of NIOSH, but not enough people to actually

00:34:26.639 --> 00:34:32.840
do the research or to do anything, right? And

00:34:32.840 --> 00:34:38.079
so, I mean, we've done everything on our end

00:34:38.079 --> 00:34:40.800
to try to see if we can keep that funding going

00:34:40.800 --> 00:34:43.059
for the last year of it. We are also getting

00:34:43.059 --> 00:34:48.409
ready to to write the second grant to follow

00:34:48.409 --> 00:34:50.510
up on the work that we've been currently doing.

00:34:50.789 --> 00:34:52.409
So we haven't started that process because we

00:34:52.409 --> 00:34:54.469
just, since we're not even sure if the grant's

00:34:54.469 --> 00:34:56.070
going to continue, we imagine it's not going

00:34:56.070 --> 00:34:59.710
to be renewed. So yeah, it's having impacts.

00:34:59.929 --> 00:35:02.349
We're supposed to have a meeting with the couple

00:35:02.349 --> 00:35:04.869
of officials that are left on NIOSH next week.

00:35:05.070 --> 00:35:09.889
So we're still hoping that some things will be

00:35:09.889 --> 00:35:13.449
turned around so we can continue this work. But

00:35:13.449 --> 00:35:15.989
yeah, NIOSH already had one of the smallest budgets

00:35:15.989 --> 00:35:18.829
that was out there, despite everybody working

00:35:18.829 --> 00:35:24.110
at some point in their life. We want to ensure

00:35:24.110 --> 00:35:26.210
the health of our workers. We want to make it

00:35:26.210 --> 00:35:28.309
to retirement. We're not just putting all these

00:35:28.309 --> 00:35:32.090
hours in to die, which many, many people in this

00:35:32.090 --> 00:35:36.449
country are. And so we need the research to show

00:35:36.449 --> 00:35:38.409
what's working, what's not working, what needs

00:35:38.409 --> 00:35:41.730
to be improved. When you look at the landscape

00:35:41.730 --> 00:35:47.230
of research, um how hard is it to fund a study

00:35:47.230 --> 00:35:50.590
that's simply showing proactive solutions versus

00:35:50.590 --> 00:35:53.949
maybe one that's really kind of going to result

00:35:53.949 --> 00:35:57.710
in some sort of drug prescription uh you know

00:35:57.710 --> 00:35:59.969
the the proactive ones it is harder right because

00:35:59.969 --> 00:36:01.849
i mean people want the solution of just like

00:36:01.849 --> 00:36:03.550
not everybody but there's most people just want

00:36:03.550 --> 00:36:05.769
a quick solution they want a pill that's why

00:36:05.769 --> 00:36:08.010
we're seeing with the glp -1 right like everyone's

00:36:08.010 --> 00:36:10.489
happy that we have a way to lose weight fast

00:36:10.489 --> 00:36:14.059
down The problem of actual interventions, as

00:36:14.059 --> 00:36:15.980
I was saying earlier, it's multi -level. You

00:36:15.980 --> 00:36:19.559
have a lot more buy -in. It takes a lot more

00:36:19.559 --> 00:36:22.960
time to go out and recruit people and build the

00:36:22.960 --> 00:36:24.860
relationships so that way you can study them

00:36:24.860 --> 00:36:27.320
to build the trust. So on the research side of

00:36:27.320 --> 00:36:29.500
things, I have a lot of work to do on the front

00:36:29.500 --> 00:36:32.760
end. Then I have to actually do the work, clean

00:36:32.760 --> 00:36:34.900
it up, write it up. But then also I want to make

00:36:34.900 --> 00:36:37.139
sure it's getting to the communities that...

00:36:37.469 --> 00:36:39.289
are important that it actually matters to, right?

00:36:39.369 --> 00:36:42.570
So not just writing for, you know, the occupational

00:36:42.570 --> 00:36:44.829
journal of stress or something, but making sure

00:36:44.829 --> 00:36:47.010
that I'm getting into trade journals as well,

00:36:47.010 --> 00:36:49.150
that I'm going to both conferences because I

00:36:49.150 --> 00:36:51.550
have to, like for the qualitative work, for example,

00:36:51.610 --> 00:36:54.610
as I went to earlier, I absolutely, I love doing

00:36:54.610 --> 00:36:56.889
qualitative research. It gives an opportunity

00:36:56.889 --> 00:36:58.829
for people to speak. And a lot of times they

00:36:58.829 --> 00:37:02.099
want to voice. what is is it isn't working which

00:37:02.099 --> 00:37:04.659
i can't capture in a survey but traditional sleep

00:37:04.659 --> 00:37:06.920
researchers don't necessarily buy that because

00:37:06.920 --> 00:37:09.539
they're like oh people are just telling you what

00:37:09.539 --> 00:37:11.760
they want i always push back on that because

00:37:11.760 --> 00:37:14.739
that's what insomnia is insomnia until we have

00:37:14.739 --> 00:37:19.239
a a sleep study that is able to um show that

00:37:19.239 --> 00:37:21.360
there are different eeg patterns for someone

00:37:21.360 --> 00:37:24.860
who has insomnia and and doesn't it is a subjective

00:37:25.949 --> 00:37:28.489
disease. And so to say, oh, people's opinion

00:37:28.489 --> 00:37:31.429
doesn't matter, doesn't make sense to me. So

00:37:31.429 --> 00:37:33.269
I have to go make sure I'm going to the science

00:37:33.269 --> 00:37:37.070
conferences to have those conversations and understand

00:37:37.070 --> 00:37:39.309
where their pushback is. And often it's like,

00:37:39.349 --> 00:37:41.610
are you sure you're controlling for sleep apnea?

00:37:41.710 --> 00:37:43.889
Or are they just telling you what they want you

00:37:43.889 --> 00:37:46.769
to hear? And then I also need to go to the trade

00:37:46.769 --> 00:37:50.630
conferences. And those are, anytime there's a

00:37:50.630 --> 00:37:52.389
firefighter, that is where I'm learning the most

00:37:52.389 --> 00:37:55.099
because I am not a firefighter. And so I'm learning

00:37:55.099 --> 00:37:57.780
from them what their challenges are, but also

00:37:57.780 --> 00:38:02.219
how to communicate the research back. And they

00:38:02.219 --> 00:38:04.519
want to hear it. They want it. And so but it's

00:38:04.519 --> 00:38:07.159
just like it's a it's a lot more than if I was

00:38:07.159 --> 00:38:10.119
just staying in a lab. Right. I I have many more

00:38:10.119 --> 00:38:12.840
angles to get to. And then, of course, you know,

00:38:12.860 --> 00:38:15.139
it's like you have if you have a union and you

00:38:15.139 --> 00:38:19.400
have the department, you have. That's twice the

00:38:19.400 --> 00:38:22.179
amount of relationships you have to build. And

00:38:22.179 --> 00:38:24.059
then depending on the city, it's like if you

00:38:24.059 --> 00:38:25.719
actually want something changed, right, then

00:38:25.719 --> 00:38:28.659
you're going to a commissioner or a council person,

00:38:28.880 --> 00:38:33.079
right? And that's another level. Maybe national

00:38:33.079 --> 00:38:35.659
unions and getting the buy -in there. There's

00:38:35.659 --> 00:38:37.900
just a lot more buy -in you need and understanding

00:38:37.900 --> 00:38:41.239
on each of those levels of the barriers to implementation.

00:38:43.179 --> 00:38:44.719
And then that's a whole other science. Science

00:38:44.719 --> 00:38:46.659
of dissemination and implementation is a whole

00:38:46.659 --> 00:38:51.280
other field of work and research that goes into

00:38:51.280 --> 00:38:53.760
that and what actually works and what is needed

00:38:53.760 --> 00:38:56.420
for someone to actually uptake and implement

00:38:56.420 --> 00:39:00.360
an intervention. Is this still the case where

00:39:00.360 --> 00:39:05.800
the metric for... sleep is still perceived tiredness?

00:39:05.880 --> 00:39:07.519
Because I remember, is it William Dement, the

00:39:07.519 --> 00:39:09.960
kind of grandfather of sleep medicine? That was

00:39:09.960 --> 00:39:12.400
how they measured for the longest time. Obviously,

00:39:12.400 --> 00:39:14.480
I know we have HRV and cortisol and some other

00:39:14.480 --> 00:39:16.940
things now, but is that still one of the main

00:39:16.940 --> 00:39:20.360
metrics that you use to kind of annotate if someone

00:39:20.360 --> 00:39:23.519
is that well or not? So that's like insomnia,

00:39:23.599 --> 00:39:25.860
right? That's what you need. So it depends on

00:39:25.860 --> 00:39:27.619
what you're measuring. I think people are leaning

00:39:27.619 --> 00:39:31.719
in to Daniel Bicey from University of Pittsburgh.

00:39:32.840 --> 00:39:37.119
conceptual of the multi -framework or multi -level

00:39:37.119 --> 00:39:40.059
sleep where you need to think about sleep regularity

00:39:40.059 --> 00:39:44.659
and sleep duration and that also includes like

00:39:44.659 --> 00:39:47.059
yeah daytime sleeping is how you feel so all

00:39:47.059 --> 00:39:49.800
of those things go into what maybe is largely

00:39:49.800 --> 00:39:53.599
called sleep health and so it's not just one

00:39:53.599 --> 00:39:57.539
thing or another So now you kind of find yourself

00:39:57.539 --> 00:40:00.659
entering the fire service. What, if any, was

00:40:00.659 --> 00:40:02.820
some of the things that surprised you as far

00:40:02.820 --> 00:40:10.079
as the hours that we actually work? So I think

00:40:10.079 --> 00:40:11.559
some of those are more surprising things. So

00:40:11.559 --> 00:40:15.639
I guess I wasn't surprised that, yeah, people

00:40:15.639 --> 00:40:18.139
were waking up multiple times per night. I think

00:40:18.139 --> 00:40:20.239
it was like the reasons when I start going into

00:40:20.239 --> 00:40:23.800
like the actual kind of calls that are. that

00:40:23.800 --> 00:40:27.219
are causing people to wake up um so yeah i think

00:40:27.219 --> 00:40:29.739
that those are that it was that and then also

00:40:29.739 --> 00:40:32.940
again this goes like into the culture so like

00:40:32.940 --> 00:40:34.840
the sleep culture of it so there are many who

00:40:34.840 --> 00:40:37.940
are like we're wearing the blue blocking glasses

00:40:37.940 --> 00:40:39.980
and we're doing this and that to try to improve

00:40:39.980 --> 00:40:43.239
our sleep but then sometimes it's simple as delaying

00:40:43.239 --> 00:40:47.679
sleep time when they're in the station because

00:40:47.679 --> 00:40:49.639
they're worried about a call that's going to

00:40:49.639 --> 00:40:54.710
come in and um so i think like So working around

00:40:54.710 --> 00:40:58.030
that, right, like that concern, I would still

00:40:58.030 --> 00:41:00.250
like lean in. You're such a large sleep debt.

00:41:00.329 --> 00:41:01.469
I can understand the concern. You're going to

00:41:01.469 --> 00:41:03.030
wake up and it'll be harder to fall asleep. If

00:41:03.030 --> 00:41:04.869
you're carrying a large sleep debt, you will

00:41:04.869 --> 00:41:06.630
still be able to go back to sleep. And it's better

00:41:06.630 --> 00:41:08.889
to, you know, advance your sleep time. So you're

00:41:08.889 --> 00:41:11.989
actually in, you know, getting closer to eight

00:41:11.989 --> 00:41:15.210
hours. Whereas, you know, if you're not even

00:41:15.210 --> 00:41:18.119
giving yourself. eight hours in bed you're certainly

00:41:18.119 --> 00:41:20.579
not going to get a full eight hours um but yeah

00:41:20.579 --> 00:41:22.860
under but so that's where it come like the insomnia

00:41:22.860 --> 00:41:24.539
comes in right like that worry and the rumination

00:41:24.539 --> 00:41:27.539
and so um i think that that surprised me and

00:41:27.539 --> 00:41:31.139
then again just the the kind of calls um that

00:41:31.139 --> 00:41:33.519
firefighters are responding to that was the other

00:41:33.519 --> 00:41:36.820
surprising thing i think one of the the lesser

00:41:36.820 --> 00:41:41.309
acknowledged elements of The fire service is

00:41:41.309 --> 00:41:44.230
the amount of hours that we work as well. When

00:41:44.230 --> 00:41:46.909
you look at law enforcement, corrections, ER

00:41:46.909 --> 00:41:49.090
physicians, all the other people that are out

00:41:49.090 --> 00:41:51.789
there doing some sort of public service and life

00:41:51.789 --> 00:41:54.530
-saving as well, it's pretty much usually a 40

00:41:54.530 --> 00:41:57.869
-hour work week. So I think this is one of the

00:41:57.869 --> 00:41:59.809
things that we really have to take a step back

00:41:59.809 --> 00:42:02.809
and kind of unlearn that this is normal, air

00:42:02.809 --> 00:42:05.960
quotes, is the fact that the... people that we

00:42:05.960 --> 00:42:09.400
expect to come running to our biggest emergencies

00:42:09.400 --> 00:42:12.619
are working 16 hours more than most people and

00:42:12.619 --> 00:42:17.440
are grossly sleep deprived as well yeah the other

00:42:17.440 --> 00:42:19.679
thing is and this is parts goes to like the education

00:42:19.679 --> 00:42:21.960
or when we're speaking about this i don't like

00:42:21.960 --> 00:42:24.500
everyone doesn't realize that a large percentage

00:42:24.500 --> 00:42:27.179
of departments in this country also provide some

00:42:27.179 --> 00:42:30.679
level of emergency medical service and i i was

00:42:30.679 --> 00:42:32.340
just giving i was giving a presentation earlier

00:42:32.340 --> 00:42:36.960
this year um where i forgot to note to that and

00:42:36.960 --> 00:42:40.619
so i had a researcher in england who's like he's

00:42:40.619 --> 00:42:42.659
like what did you account for sedentary sedentary

00:42:42.659 --> 00:42:45.079
behavior because like most of the time firefighters

00:42:45.079 --> 00:42:46.760
are just like sitting there in their station

00:42:46.760 --> 00:42:49.440
i was like no don't you see where i have like

00:42:49.440 --> 00:42:51.420
this graph or call volume what are you talking

00:42:51.420 --> 00:42:54.440
about um but that's because at least in his area

00:42:54.440 --> 00:42:58.659
i'm not familiar with england generally but for

00:42:58.659 --> 00:43:01.590
his department that he was aware of um they don't

00:43:01.590 --> 00:43:04.670
provide emergency medical services. So yes, they

00:43:04.670 --> 00:43:07.929
don't have a large load than if they're truly

00:43:07.929 --> 00:43:12.150
just only responding to fire. Yeah. So this is

00:43:12.150 --> 00:43:14.250
the thing, you know, I think that we're seeing

00:43:14.250 --> 00:43:16.809
now, it's as beautiful as a shift to a 42 -hour

00:43:16.809 --> 00:43:19.849
workweek. So in Florida, as I sit here, the 10th

00:43:19.849 --> 00:43:21.650
fire department just announced that they've got

00:43:21.650 --> 00:43:23.329
one more hurdle, but they're basically about

00:43:23.329 --> 00:43:26.900
to go to the 2472. Because, and we'll get into

00:43:26.900 --> 00:43:28.739
this, you know, what you see in the fire service

00:43:28.739 --> 00:43:32.199
prior to arguably a few short years ago is, well,

00:43:32.280 --> 00:43:34.880
let's just move around the Rubik's cube that

00:43:34.880 --> 00:43:37.239
is the 56 hour work week and change the days

00:43:37.239 --> 00:43:39.780
around without having the conversation of, well,

00:43:39.780 --> 00:43:42.019
why is this cube so big? Why are we even working

00:43:42.019 --> 00:43:47.159
56 hours in the first place? Yeah, exactly. So

00:43:47.159 --> 00:43:50.320
with that, let's get the exposure. I had Joel

00:43:50.320 --> 00:43:53.900
Billings on, and I know he talked about his 4896

00:43:53.900 --> 00:43:58.760
study, and we discussed it. The way that it was

00:43:58.760 --> 00:44:02.679
laid out, understandably, when you're comparing

00:44:02.679 --> 00:44:06.139
it to 2448 in that particular environment, in

00:44:06.139 --> 00:44:08.260
that very, very quiet department, it was some

00:44:08.260 --> 00:44:10.800
interesting data that came out of it. The problem

00:44:10.800 --> 00:44:13.670
is that... massive urban departments looked at

00:44:13.670 --> 00:44:15.809
that and then went oh that's the best schedule

00:44:15.809 --> 00:44:18.469
and ran with it and i feel like we're now and

00:44:18.469 --> 00:44:21.369
it's no fault of joel's whatsoever a little knowledge

00:44:21.369 --> 00:44:24.469
is a dangerous thing as they say um now we're

00:44:24.469 --> 00:44:26.349
getting people that have gone to 40 you know

00:44:26.349 --> 00:44:30.050
48 hours without sleep and the huge you know

00:44:30.050 --> 00:44:33.809
i mean arguably dangerous uh result that that

00:44:33.809 --> 00:44:35.250
has when you're behind the wheel with you're

00:44:35.250 --> 00:44:37.150
pushing drugs with you climbing 100 foot aerial

00:44:37.150 --> 00:44:40.489
etc but that being said that all that aside so

00:44:41.059 --> 00:44:44.280
What were, what was the first thing that you

00:44:44.280 --> 00:44:46.739
kind of got involved with as far as shift work

00:44:46.739 --> 00:44:49.920
within the fire service? Yeah. So I just mentioned,

00:44:49.940 --> 00:44:54.659
so Joel and I were both, so I put on a, I think

00:44:54.659 --> 00:44:59.400
it was called rest under fire. It's a panel at

00:44:59.400 --> 00:45:01.579
the sleep conference on sleep and firefighter

00:45:01.579 --> 00:45:03.239
health. And so he was on that panel as well.

00:45:03.239 --> 00:45:06.179
So I saw him last week and then I'm doing something

00:45:06.179 --> 00:45:08.860
with him later in the summer. So, yeah, I'm getting

00:45:08.860 --> 00:45:12.599
to know Joel. But, yeah, so the Portland Fire

00:45:12.599 --> 00:45:15.500
and Rescue reached out to us asking what is the

00:45:15.500 --> 00:45:18.539
best schedule for their health. And so they had

00:45:18.539 --> 00:45:20.119
done a literature review, but we went back and

00:45:20.119 --> 00:45:22.820
did a literature review because at that time

00:45:22.820 --> 00:45:24.780
I had worked with transit. So I was familiar

00:45:24.780 --> 00:45:26.340
with that. And one of my colleagues had worked

00:45:26.340 --> 00:45:28.900
with transit out here and nurses. So that was

00:45:28.900 --> 00:45:31.599
the populations that we had previously worked

00:45:31.599 --> 00:45:34.840
with. before that other than like my local fire

00:45:34.840 --> 00:45:37.840
department did not know anything and so yeah

00:45:37.840 --> 00:45:40.260
we just spent time discussing with them i had

00:45:40.260 --> 00:45:42.940
a needs assessment with them that's also why

00:45:42.940 --> 00:45:45.559
like i i i do focus groups and whatnot right

00:45:45.559 --> 00:45:48.159
because i recognize what i don't know and so

00:45:48.159 --> 00:45:50.579
first i was like well why like my first question

00:45:50.579 --> 00:45:51.980
is why are you looking for a different schedule

00:45:51.980 --> 00:45:54.780
like what is not working with so portland was

00:45:54.780 --> 00:45:57.460
working the 24 48 and so we had focus groups

00:45:57.460 --> 00:46:01.420
to learn what do you want for sleep? What does

00:46:01.420 --> 00:46:03.559
perfect sleep look for you in the department?

00:46:03.699 --> 00:46:06.039
What does it look like for at home? And we also

00:46:06.039 --> 00:46:08.559
included family because it became very clear

00:46:08.559 --> 00:46:11.820
that that is an important part about the, both

00:46:11.820 --> 00:46:14.260
given that they're away from home for at least

00:46:14.260 --> 00:46:17.199
24 hours, like the conflict that's there, but

00:46:17.199 --> 00:46:20.219
then also that potentially introduces a conflict

00:46:20.219 --> 00:46:22.579
when people are coming home, whether it's the

00:46:22.579 --> 00:46:26.440
ability to try to fall asleep or because of like

00:46:26.440 --> 00:46:28.880
the, FOMO of like, I'm missing out on things.

00:46:28.940 --> 00:46:31.739
I want to be part of my family. I'm tired, but

00:46:31.739 --> 00:46:33.539
I also want to be there for them. Right. And

00:46:33.539 --> 00:46:36.940
so that just gave a great opportunity to learn

00:46:36.940 --> 00:46:40.659
about all of that and the different, again, the

00:46:40.659 --> 00:46:45.280
different barriers to getting sleep. And so from

00:46:45.280 --> 00:46:46.840
that at the time, they were thinking about the

00:46:46.840 --> 00:46:49.820
4896. It was specifically the wellness group

00:46:49.820 --> 00:46:52.420
from the union that came to us with the recognition

00:46:52.420 --> 00:46:56.150
that we are, there are some very busy. stations

00:46:56.150 --> 00:46:59.469
here they could be up 48 hours obviously that's

00:46:59.469 --> 00:47:01.670
not good for their health so can you give us

00:47:01.670 --> 00:47:04.909
the data to show it and so as you're well aware

00:47:04.909 --> 00:47:07.090
like literature -wise there are not purely just

00:47:07.090 --> 00:47:10.289
like at the time there's one or two studies specifically

00:47:10.289 --> 00:47:13.070
just looking at schedules but we leaned in on

00:47:13.070 --> 00:47:15.909
the laboratory work and we actually worked with

00:47:15.909 --> 00:47:18.369
andrew phillips who's out in australia to develop

00:47:18.369 --> 00:47:21.250
models um based on the psychomotor vigilance

00:47:21.250 --> 00:47:23.800
test that's Very common test that's been used

00:47:23.800 --> 00:47:27.800
in laboratories to look at levels of alertness.

00:47:28.199 --> 00:47:30.079
And then often that's paired with like subjective

00:47:30.079 --> 00:47:32.300
measures of like how sleepy you are. And those

00:47:32.300 --> 00:47:34.559
studies show that people are just not good at

00:47:34.559 --> 00:47:37.320
noting. They just don't match, right? You're

00:47:37.320 --> 00:47:39.199
objectively, you're going to be much worse than

00:47:39.199 --> 00:47:44.050
how you feel. and so we we ran models based on

00:47:44.050 --> 00:47:46.429
those focus groups those conversations we had

00:47:46.429 --> 00:47:49.030
with firefighters on how much their sleep they're

00:47:49.030 --> 00:47:51.210
getting if they're on a low call volumes department

00:47:51.210 --> 00:47:53.610
medium and then we did like a high call volume

00:47:53.610 --> 00:47:55.989
where for high call volume we're making the assumptions

00:47:55.989 --> 00:47:58.130
that they couldn't take naps during the day and

00:47:58.130 --> 00:48:01.389
have very disrupted sleep at night and then we

00:48:01.389 --> 00:48:05.500
made the which I now recognize eight years later

00:48:05.500 --> 00:48:07.420
is not correct, but we made the assumption, okay,

00:48:07.500 --> 00:48:09.139
but at home, they're going to get eight hours

00:48:09.139 --> 00:48:11.219
of recovery sleep. And so we ran those models

00:48:11.219 --> 00:48:14.179
based on that. And the 4896 performed the worst.

00:48:16.199 --> 00:48:18.079
2448 was the best. And then Portland had come

00:48:18.079 --> 00:48:20.480
up with this alternative schedule that kind of

00:48:20.480 --> 00:48:23.820
married the two worlds together called 1323.

00:48:24.179 --> 00:48:27.780
So they moved from D's to our notation. And that

00:48:27.780 --> 00:48:30.860
schedule was in between. And so the real issue

00:48:30.860 --> 00:48:34.079
with why the schedules that give any amount of

00:48:34.079 --> 00:48:37.000
consecutive time off is because, and so I should

00:48:37.000 --> 00:48:40.099
pause and say, for those that are getting at

00:48:40.099 --> 00:48:43.420
least six and a half hours of sleep on shift,

00:48:43.659 --> 00:48:46.539
they were fine. There was no levels of high levels

00:48:46.539 --> 00:48:49.820
of impairment. And so if you're able to get rounded

00:48:49.820 --> 00:48:52.099
up to seven hours of sleep, then you'll be okay.

00:48:53.139 --> 00:48:55.639
But for anyone who's getting in the moderate

00:48:55.639 --> 00:48:57.260
and the high call where we said maybe they're

00:48:57.260 --> 00:49:00.079
getting four to five hours, even just like losing

00:49:00.079 --> 00:49:05.170
three, or four hours of sleep twice, it's really

00:49:05.170 --> 00:49:07.530
hard to make up for the two consecutive nights

00:49:07.530 --> 00:49:12.429
of sleep loss. And so even if they had four days

00:49:12.429 --> 00:49:15.369
off, or we also built Kelly days and we had versions

00:49:15.369 --> 00:49:17.489
of the models that included Kelly days. So for

00:49:17.489 --> 00:49:20.510
the 24, 48, it's five days off or one, three,

00:49:20.550 --> 00:49:23.210
two, three. I can't put, I don't know if it was

00:49:23.210 --> 00:49:25.730
still five. I'd have to picture it. But we also

00:49:25.730 --> 00:49:27.429
did like trades and stuff like that. So it probably

00:49:27.429 --> 00:49:29.190
gave still times where people were like off for

00:49:29.190 --> 00:49:32.099
seven days in a row. it still wasn't enough to

00:49:32.099 --> 00:49:35.699
consistently make up for those also rather consistent

00:49:35.699 --> 00:49:38.760
times of sleep loss um so that was all just based

00:49:38.760 --> 00:49:42.380
on modeling though i came back we presented that

00:49:42.380 --> 00:49:43.840
but we're like we're not fully answering your

00:49:43.840 --> 00:49:45.840
question though you want to know you know you

00:49:45.840 --> 00:49:47.400
didn't actually ask us about alertness that's

00:49:47.400 --> 00:49:49.880
what we could do from the labs um you want to

00:49:49.880 --> 00:49:50.940
know about your health like you want to know

00:49:50.940 --> 00:49:52.360
about cardiovascular health you want to know

00:49:52.360 --> 00:49:53.820
about weight gain like we actually have to do

00:49:53.820 --> 00:49:56.500
a study to see because we don't know so yeah

00:49:56.500 --> 00:50:00.539
so that's what we um did then they voted to give

00:50:00.539 --> 00:50:04.739
it a trial period um and so yeah and so we've

00:50:04.739 --> 00:50:07.320
followed them since then we're trying to generalize

00:50:07.320 --> 00:50:09.280
it um because it is still just one department

00:50:09.280 --> 00:50:14.360
and they um are more um I don't want to say the

00:50:14.360 --> 00:50:16.059
answer, but like they have, again, like the individual

00:50:16.059 --> 00:50:18.679
sleeping rooms, individual tap outs for calls

00:50:18.679 --> 00:50:21.719
they have previously. And they still have like

00:50:21.719 --> 00:50:25.940
fitness support, peer support based on Carrie

00:50:25.940 --> 00:50:29.599
Kuhl's work. And so they have they do have a

00:50:29.599 --> 00:50:31.380
lot of support in mental health, peer support

00:50:31.380 --> 00:50:34.179
as well. And so we want to be able to generalize

00:50:34.179 --> 00:50:36.400
that. So we've been able to do a couple of other

00:50:36.400 --> 00:50:39.900
departments in Oregon and are trying to also.

00:50:40.840 --> 00:50:44.019
bring in other schedules, so the 4896, the Berkeley,

00:50:44.280 --> 00:50:47.119
to really just be able to systematically say,

00:50:47.239 --> 00:50:50.059
this is the impact of consecutive days on versus

00:50:50.059 --> 00:50:53.840
consecutive days off and show it quantitatively.

00:50:54.840 --> 00:50:56.980
And again, because it's of interest for those,

00:50:57.119 --> 00:50:59.199
again, there's the literature to show this is

00:50:59.199 --> 00:51:01.440
the impact when you don't sleep, but to show

00:51:01.440 --> 00:51:03.280
it systematically and the firefighter department

00:51:03.280 --> 00:51:06.280
is our goal. What were the work weeks of the

00:51:06.280 --> 00:51:08.539
transit people and the nurses that you studied?

00:51:08.619 --> 00:51:11.880
How many hours a week were they working? Yeah,

00:51:11.880 --> 00:51:15.260
I would say the nurses can, you know, there is

00:51:15.260 --> 00:51:17.619
definitely some overtime there. And I would nursing.

00:51:18.940 --> 00:51:21.219
I mean, on average, it's probably like a 36 hour

00:51:21.219 --> 00:51:23.699
week, but it's very dependent on like if they

00:51:23.699 --> 00:51:26.400
have a union versus they're not unionized. So

00:51:26.400 --> 00:51:28.980
they can spread. But I would say on average,

00:51:29.000 --> 00:51:32.760
it's probably about a 36 hour week, often in

00:51:32.760 --> 00:51:36.539
like three 12 hour shifts for transit. It was

00:51:36.539 --> 00:51:39.500
like a 40 hour week. Yeah. Yeah. So this is what's

00:51:39.500 --> 00:51:41.980
crazy is, and, and this is, this is what I've

00:51:41.980 --> 00:51:44.440
seen over and over again is when people have

00:51:44.440 --> 00:51:46.239
this conversation again, we're spinning the cube

00:51:46.239 --> 00:51:50.219
versus saying, well, another option is to do,

00:51:50.219 --> 00:51:52.320
you know, have a D shift. And it's interesting

00:51:52.320 --> 00:51:54.460
because in your area, the Pacific Northwest,

00:51:54.599 --> 00:51:57.559
there's more departments than I realized that

00:51:57.559 --> 00:52:00.260
have four shifts. Now they have debit days, which

00:52:00.260 --> 00:52:02.300
again, especially Washington, especially Washington

00:52:02.300 --> 00:52:04.840
is like, yeah, they're on it there. Yeah. So

00:52:04.840 --> 00:52:06.800
the question begs, you know, why is that not

00:52:06.800 --> 00:52:09.710
being. asked to be studied as well you know just

00:52:09.710 --> 00:52:11.690
because we've done it this way i tell people

00:52:11.690 --> 00:52:13.550
we've done it this way and then the ultimate

00:52:13.550 --> 00:52:16.849
longitudinal study is how not to do it because

00:52:16.849 --> 00:52:19.130
look at the ill health of our firefighters at

00:52:19.130 --> 00:52:21.670
the moment look at the obesity look at the you

00:52:21.670 --> 00:52:24.030
know even relationship wise you know the divorces

00:52:24.030 --> 00:52:25.989
and all these other things i would argue we've

00:52:25.989 --> 00:52:28.750
got a great amount of data but it's in the wrong

00:52:28.750 --> 00:52:32.730
way so why not study a better version of it rather

00:52:32.730 --> 00:52:35.250
than just keep moving the cups you know as it

00:52:35.250 --> 00:52:39.650
were in the cup game Yeah. The other thing that

00:52:39.650 --> 00:52:41.409
Washington does that, like, as I've talked to

00:52:41.409 --> 00:52:44.429
other departments, and again, often it's like

00:52:44.429 --> 00:52:48.449
because of union relationships, a lot of departments

00:52:48.449 --> 00:52:51.550
in Washington have a limit on a number of consecutive

00:52:51.550 --> 00:52:53.909
hours you're allowed to work on shift. So there's,

00:52:53.909 --> 00:52:57.309
you know, the issue of like the 1323 or the 4896,

00:52:57.389 --> 00:52:58.809
I've talked to people who are like, oh, yeah,

00:52:58.849 --> 00:53:01.530
we have people who work 128 hours, right? And

00:53:01.530 --> 00:53:05.550
the 1323. There's an increased amount of 72 hours

00:53:05.550 --> 00:53:07.449
on shift. But yeah, in Washington, they're like,

00:53:07.510 --> 00:53:09.409
you're not allowed to work more than 48 hours.

00:53:09.469 --> 00:53:11.530
Like it's just a clear rule. And so, yeah, they

00:53:11.530 --> 00:53:14.809
have been on the cutting edge. But yeah, I haven't

00:53:14.809 --> 00:53:18.190
been able to study any of those departments.

00:53:18.670 --> 00:53:20.650
Yeah. So this is the thing when people say, well,

00:53:20.690 --> 00:53:22.230
have you got the data? I was like, again, no

00:53:22.230 --> 00:53:24.750
one is studying the 2472. Now I take that back

00:53:24.750 --> 00:53:29.710
because FSU is studying Gainesville and Destin.

00:53:30.079 --> 00:53:32.079
They've got baseline, and now obviously they've

00:53:32.079 --> 00:53:33.460
got to wait for a little while before they can

00:53:33.460 --> 00:53:37.280
get some first -time round results. Then I believe

00:53:37.280 --> 00:53:41.460
there's an organization related to Harvard. Again,

00:53:41.619 --> 00:53:43.179
I don't think they can say they're Harvard because

00:53:43.179 --> 00:53:46.139
of cuts and all that stuff, but I know they're

00:53:46.139 --> 00:53:47.880
looking at one of the departments that's about

00:53:47.880 --> 00:53:51.400
to go as well, Palm Beach. There will be some

00:53:51.400 --> 00:53:53.760
data coming, but again, it really goes back to,

00:53:53.860 --> 00:53:56.460
well, it's also what do you expect to happen

00:53:56.460 --> 00:53:58.619
if you give these people an extra 24 hours between

00:53:58.619 --> 00:54:00.670
their shifts? Of course. these things are going

00:54:00.670 --> 00:54:02.710
to improve. And like you said, it's not the only

00:54:02.710 --> 00:54:05.889
thing, but even like you mentioned the FOMO,

00:54:05.889 --> 00:54:08.309
say you're in a quieter department, but you still

00:54:08.309 --> 00:54:11.230
have to be gone for 56 hours. It doesn't matter

00:54:11.230 --> 00:54:12.989
whether you ran calls, you're still away from

00:54:12.989 --> 00:54:15.050
your family. So that's still going to have an

00:54:15.050 --> 00:54:17.250
impact. You know, yeah. The more tired you are,

00:54:17.289 --> 00:54:19.760
the more it's going to bleed over. But getting

00:54:19.760 --> 00:54:21.239
our men and women home when they're supposed

00:54:21.239 --> 00:54:23.900
to be, like the banker and the grocery clerk

00:54:23.900 --> 00:54:26.619
and everyone else that works 40 hours, this is

00:54:26.619 --> 00:54:28.599
the conversation that I feel that we need to

00:54:28.599 --> 00:54:30.860
be really pushing in the fire service to stop

00:54:30.860 --> 00:54:33.739
saying 56 hours is normal. And even, you know,

00:54:33.760 --> 00:54:43.369
like the 1323. that's termed as days and it's

00:54:43.369 --> 00:54:45.369
not a day you know i mean it's it's an actual

00:54:45.369 --> 00:54:47.309
24 -hour day but it's not a work day you know

00:54:47.309 --> 00:54:49.929
so we say one on two off it's like that's three

00:54:49.929 --> 00:54:53.110
three eight hour days crammed together so that

00:54:53.110 --> 00:54:55.829
would be uh you know three three six three is

00:54:55.829 --> 00:54:58.110
actually what it would be so when we reframe

00:54:58.110 --> 00:55:01.429
it in a way that people understand no no civilian

00:55:01.429 --> 00:55:05.610
calls 24 hours one day's work just just we do

00:55:05.610 --> 00:55:08.369
you know so i'm hoping this is you know joel's

00:55:08.369 --> 00:55:10.170
talked about it and sarah jenky they're kind

00:55:10.170 --> 00:55:12.460
of I think they're going to be pushing towards

00:55:12.460 --> 00:55:15.219
researching some of that side now rather than

00:55:15.219 --> 00:55:18.380
looking at this 56 -hour week that we already

00:55:18.380 --> 00:55:21.099
know the impacts of that because we see it in

00:55:21.099 --> 00:55:26.239
the ill health of our people. So with that being

00:55:26.239 --> 00:55:28.960
said, I would love to, through your eyes, kind

00:55:28.960 --> 00:55:34.019
of unpack some of those ill effects. So whether

00:55:34.019 --> 00:55:36.000
it's in the fire service or whether it's previous

00:55:36.000 --> 00:55:38.980
occupations that you've studied, let's start

00:55:38.980 --> 00:55:41.460
with mental health. What is the relationship

00:55:41.460 --> 00:55:44.059
between mental sleep deprivation, excuse me,

00:55:44.079 --> 00:55:46.719
and mental health? Yeah, I would say that's probably

00:55:46.719 --> 00:55:49.619
the strongest relationship or what we have data

00:55:49.619 --> 00:55:51.280
on, right? Like there's a very clear relationship

00:55:51.280 --> 00:55:56.079
between mental health and sleep disorders. And

00:55:56.079 --> 00:55:59.559
even just like object or subjectively, it's something

00:55:59.559 --> 00:56:02.300
that people can easily point to. It's like, even

00:56:02.300 --> 00:56:05.480
if they can't. and inherently say, oh, yes, I

00:56:05.480 --> 00:56:07.840
am sleepy, they know, okay, I'm a little more

00:56:07.840 --> 00:56:09.699
irritable. I'm a little more moody right now,

00:56:09.739 --> 00:56:12.480
right? And so, yeah, I mean, that is one of the

00:56:12.480 --> 00:56:14.199
clearest relationships that we've been able to

00:56:14.199 --> 00:56:17.019
identify. And what about like more chronically?

00:56:17.159 --> 00:56:18.880
I mean, I know there is a lot of research out

00:56:18.880 --> 00:56:20.780
there, but have you yourself seen the impact

00:56:20.780 --> 00:56:23.539
as far as, you know, suicide, addiction, some

00:56:23.539 --> 00:56:25.800
of these, you know, more chronic and deadly elements?

00:56:26.409 --> 00:56:29.190
Yeah, so I haven't like I the for suicide measures,

00:56:29.230 --> 00:56:33.409
we haven't captured that. But yeah, I mean, but

00:56:33.409 --> 00:56:34.730
yeah, for like the mood and things like that,

00:56:34.789 --> 00:56:37.889
we certainly do see it. That's one interesting

00:56:37.889 --> 00:56:41.150
thing about the and this will, I'm sure go on

00:56:41.150 --> 00:56:44.889
with the 2474 is like that for the 1323, the

00:56:44.889 --> 00:56:47.610
ability to have like that consecutive time at

00:56:47.610 --> 00:56:49.909
home. So even if they are more, you know, have

00:56:49.909 --> 00:56:52.670
those 48 hours. that ability to have like more

00:56:52.670 --> 00:56:55.489
time away from work that they're able to detach

00:56:55.489 --> 00:57:00.750
more um they're able to um engage in more mastery

00:57:00.750 --> 00:57:02.989
skills right so i think like and this is one

00:57:02.989 --> 00:57:05.409
of those things whenever i talk to academia it's

00:57:05.409 --> 00:57:07.550
like well did you account for them working second

00:57:07.550 --> 00:57:10.869
jobs and and i do push back on that because yes

00:57:10.869 --> 00:57:12.829
that happens but it happens one because maybe

00:57:12.829 --> 00:57:15.150
financial concerns maybe that their department

00:57:15.150 --> 00:57:18.190
doesn't actually pay like a living wage um but

00:57:18.190 --> 00:57:20.699
then often people are just doing things on their

00:57:20.699 --> 00:57:23.579
time off that might be also working right taking

00:57:23.579 --> 00:57:26.340
care of children needing to be a caregiver of

00:57:26.340 --> 00:57:31.019
maybe children and um a parent right um and then

00:57:31.019 --> 00:57:32.699
some people just have hobbies that are equivalent

00:57:32.699 --> 00:57:34.940
to people's jobs like there are people who do

00:57:34.940 --> 00:57:36.719
construction for fun but then there are people

00:57:36.719 --> 00:57:38.760
who are doing construction for paid work so i

00:57:38.760 --> 00:57:41.340
i think if that is a concern then we need to

00:57:41.340 --> 00:57:43.139
do a better job of like that needs to be written

00:57:43.139 --> 00:57:45.219
into the policy you're not allowed to do this

00:57:45.219 --> 00:57:48.079
on this day off um and so then that's a mutual

00:57:48.079 --> 00:57:51.239
understanding or having some type of fatigue

00:57:51.239 --> 00:57:53.980
management system in place, which maybe will

00:57:53.980 --> 00:57:57.780
also promote people prioritizing sleep at home

00:57:57.780 --> 00:58:00.159
because they know that there's going to be a

00:58:00.159 --> 00:58:04.099
PVT test when they come in. And implementing

00:58:04.099 --> 00:58:06.820
that would also show that across 24 hours, that

00:58:06.820 --> 00:58:10.400
is deteriorating. And again, we need the proper

00:58:10.400 --> 00:58:14.099
recovery time to boost that back up. Sorry, I

00:58:14.099 --> 00:58:15.559
lost what I was originally going to say. Oh,

00:58:15.559 --> 00:58:17.780
so yeah, we see that with those three days off,

00:58:17.840 --> 00:58:21.639
people do have work -life balance is improving

00:58:21.639 --> 00:58:25.400
both for the spouse and for the firefighter.

00:58:26.440 --> 00:58:29.059
And that they're able to note that like their

00:58:29.059 --> 00:58:31.360
social engagement is better because they are

00:58:31.360 --> 00:58:35.280
able to have more of it. I remember even just

00:58:35.280 --> 00:58:37.000
like, again, going back to like qualitative work,

00:58:37.119 --> 00:58:39.650
it was a concern, like go. firefighters on the

00:58:39.650 --> 00:58:42.269
1323 not everybody wanted to move to it some

00:58:42.269 --> 00:58:44.010
were concerned that they're going to be away

00:58:44.010 --> 00:58:48.349
from their home for 48 hours sometimes um but

00:58:48.349 --> 00:58:50.590
then on the back side it's like actually this

00:58:50.590 --> 00:58:52.949
has worked out better like my relationships improved

00:58:52.949 --> 00:58:56.159
um My, you know, they, they, they figured that

00:58:56.159 --> 00:59:00.360
out. And it's like the, having the more time

00:59:00.360 --> 00:59:03.000
at home has been more beneficial to make up for,

00:59:03.019 --> 00:59:05.260
you know, those 24 hours or so when they're not

00:59:05.260 --> 00:59:08.780
to the point where like 96 people, percent of

00:59:08.780 --> 00:59:10.679
people are, they want these other schedules.

00:59:11.579 --> 00:59:15.260
Even before it was like 70 % were like interested

00:59:15.260 --> 00:59:17.699
in thinking about it. Some of them still like

00:59:17.699 --> 00:59:19.659
cautiously. So, but then it was like, nope, we

00:59:19.659 --> 00:59:22.389
like this. i think the four percent comes from

00:59:22.389 --> 00:59:24.269
those with really high call volume departments

00:59:24.269 --> 00:59:26.889
which i keep coming back to like that is an issue

00:59:26.889 --> 00:59:30.190
like the volume needs to be addressed and um

00:59:30.190 --> 00:59:32.730
and then individuals who are divorced right like

00:59:32.730 --> 00:59:37.550
having to renegotiate um agreements with uh their

00:59:37.550 --> 00:59:40.039
exes and things like that Yeah. Yeah. It would

00:59:40.039 --> 00:59:41.500
be interesting if you put them, you know, you've

00:59:41.500 --> 00:59:45.239
got the 2448, you've got the 1323, or you've

00:59:45.239 --> 00:59:47.679
got the 1313. Which of these would you like?

00:59:48.139 --> 00:59:50.460
Yeah, of course. You know, you know, that was

00:59:50.460 --> 00:59:54.619
like in the qualitative work is like, this is

00:59:54.619 --> 00:59:57.659
great, but we would like, yeah, so. Absolutely.

00:59:57.760 --> 00:59:59.159
Well, it's interesting as well, because you've

00:59:59.159 --> 01:00:01.239
mirrored what I've heard from people. And it's,

01:00:01.239 --> 01:00:04.320
it's, it really does kind of anger me because

01:00:04.320 --> 01:00:07.840
when someone arguably who usually works nine

01:00:07.840 --> 01:00:10.380
to five, 40 hours a week says, well, if we give

01:00:10.380 --> 01:00:12.239
our firefighters more time off, they'll just

01:00:12.239 --> 01:00:14.719
work on their days off. I think that's a very

01:00:14.719 --> 01:00:17.099
arrogant thing to say that you control people

01:00:17.099 --> 01:00:19.519
even when they're not wearing the uniform. But

01:00:19.519 --> 01:00:23.440
especially when the lack of leadership has contributed

01:00:23.440 --> 01:00:27.199
to holes in staffing that these men and women

01:00:27.199 --> 01:00:29.280
are filling, that is their overtime. That is

01:00:29.280 --> 01:00:31.800
why they are working more. So if you create an

01:00:31.800 --> 01:00:33.860
environment where recruitment goes up again and

01:00:33.860 --> 01:00:35.989
you fill all these spaces, Well, then you've

01:00:35.989 --> 01:00:38.530
solved one part of that immediately because now

01:00:38.530 --> 01:00:41.309
the people are only working the shifts that they're

01:00:41.309 --> 01:00:43.630
supposed to be working. The other thing as well,

01:00:43.650 --> 01:00:46.769
and you said it yourself, when... There's two

01:00:46.769 --> 01:00:49.710
types of working on your days off. There's irresponsible

01:00:49.710 --> 01:00:52.190
working. I'm going to go work overnight in the

01:00:52.190 --> 01:00:53.789
ER. I'm going to work for a private ambulance

01:00:53.789 --> 01:00:56.469
company. And there's responsible working. I'm

01:00:56.469 --> 01:00:58.929
a landscaper. I'm a personal trainer. I'm whatever.

01:00:59.369 --> 01:01:01.010
And I'm going to work during the day and I'll

01:01:01.010 --> 01:01:02.630
be home with my family at night. I'll be tired.

01:01:02.769 --> 01:01:04.809
I would have had a different community that I've

01:01:04.809 --> 01:01:06.750
been working in. So building even more relationships,

01:01:06.969 --> 01:01:08.949
I'm going to be healthier and happier. And I'm

01:01:08.949 --> 01:01:11.719
going to sleep like a baby that night. So understanding

01:01:11.719 --> 01:01:14.440
that, yeah, having something in place saying,

01:01:14.539 --> 01:01:16.739
you know, you are not allowed to take a job that

01:01:16.739 --> 01:01:18.940
will keep you awake all night for yet another

01:01:18.940 --> 01:01:21.679
day. I couldn't agree more with that. But saying

01:01:21.679 --> 01:01:24.059
you can't work on your days off, completely wrong

01:01:24.059 --> 01:01:27.940
way of doing it. Yeah, I should have written

01:01:27.940 --> 01:01:29.019
it down. There's something else there you said

01:01:29.019 --> 01:01:30.320
that I was like, oh, I know. So we're just going

01:01:30.320 --> 01:01:32.360
back to the one, three, two, three. So the other

01:01:32.360 --> 01:01:34.760
reason why I should note that. The reason Portland

01:01:34.760 --> 01:01:37.300
went with that schedule is because they feel

01:01:37.300 --> 01:01:39.179
like it's a way for them to be able to get to

01:01:39.179 --> 01:01:41.980
the 1313. So that is their goal. And it's a way

01:01:41.980 --> 01:01:45.539
of like just do negotiations over time that they

01:01:45.539 --> 01:01:47.639
can get there. And so they have already moved.

01:01:47.820 --> 01:01:50.320
So they used to have a Kelly Day every 13 shifts

01:01:50.320 --> 01:01:53.780
and now it's every nine shifts. And so with those

01:01:53.780 --> 01:01:56.159
negotiations, that gives like the department

01:01:56.159 --> 01:02:02.420
or the city time to budget or whatnot. But but

01:02:02.420 --> 01:02:04.699
the recruitment levels are issues because like

01:02:04.699 --> 01:02:06.500
there was a report that was like, you guys are

01:02:06.500 --> 01:02:09.039
still massively understaffed. And then there's

01:02:09.039 --> 01:02:11.260
going to be a huge retirement wave coming up.

01:02:11.380 --> 01:02:13.260
And so I'm not sure how they're going to actually

01:02:13.260 --> 01:02:15.440
get there with the numbers without like still

01:02:15.440 --> 01:02:17.539
just having mandatory overtime, which then they're

01:02:17.539 --> 01:02:19.739
not moving towards that actual direction. But

01:02:19.739 --> 01:02:22.519
that is their goal. You have like them trying

01:02:22.519 --> 01:02:24.980
to make that work. It's I mean, it's so weird

01:02:24.980 --> 01:02:28.099
because I'm who am I? I'm an immigrant from England

01:02:28.099 --> 01:02:29.880
that became a firefighter and never rose above

01:02:29.880 --> 01:02:33.289
that rank. But. And listening to people like

01:02:33.289 --> 01:02:35.010
yourself and all these other people and working

01:02:35.010 --> 01:02:37.090
for various departments and getting a kind of

01:02:37.090 --> 01:02:40.070
East and West Coast perspective, gypsy firefighter,

01:02:40.090 --> 01:02:43.730
as you were, you're on the outside looking in

01:02:43.730 --> 01:02:46.170
more. And so when people say kind of knee jerk

01:02:46.170 --> 01:02:48.590
things, you get to step back and go, but that

01:02:48.590 --> 01:02:50.710
doesn't make sense. And one of the things is,

01:02:50.849 --> 01:02:52.809
well, for example, the departments that have

01:02:52.809 --> 01:02:55.030
three people on an engine or a truck, and they're

01:02:55.030 --> 01:02:56.809
like, we want to get to four person staffing

01:02:56.809 --> 01:03:00.880
first, and then we'll look at the 2472. And I

01:03:00.880 --> 01:03:02.219
tell them, you've got it completely backwards.

01:03:02.300 --> 01:03:06.039
If you are struggling to hire people now, what

01:03:06.039 --> 01:03:07.900
makes you think you have the staffing to add

01:03:07.900 --> 01:03:10.320
a Kelly day or to add an extra person on the

01:03:10.320 --> 01:03:13.219
truck? It's the other way around. Create the

01:03:13.219 --> 01:03:15.699
environment that excites young people to put

01:03:15.699 --> 01:03:19.139
this uniform on, and then you will have the staffing

01:03:19.139 --> 01:03:21.940
for the things that you're looking for. So the

01:03:21.940 --> 01:03:24.510
departments that have done it really well. And

01:03:24.510 --> 01:03:27.010
very few departments can say, hey, we're going

01:03:27.010 --> 01:03:28.829
to go to it and just go to overnight. Of course,

01:03:28.829 --> 01:03:31.130
it's got to be the size of the county or city.

01:03:31.269 --> 01:03:33.650
It's going to take a few years. But they announce

01:03:33.650 --> 01:03:37.090
we are going to the 24 -72. And then we are going

01:03:37.090 --> 01:03:39.090
to take three or four years. The year one will

01:03:39.090 --> 01:03:41.469
be a six -day Cali day because we'll hire the

01:03:41.469 --> 01:03:43.710
people to fill those positions. Then a three

01:03:43.710 --> 01:03:47.190
-day, then a D -shift with debit days, and then

01:03:47.190 --> 01:03:49.679
a full D -shift. And so this is, I think, what

01:03:49.679 --> 01:03:51.159
people have got to get their head around is that

01:03:51.159 --> 01:03:53.059
you've got to draw a line in the sand and say

01:03:53.059 --> 01:03:55.099
enough is enough. Because if recruitment is bad

01:03:55.099 --> 01:03:57.420
now and you're not fixing anything, it's going

01:03:57.420 --> 01:04:00.039
to be worse a year from now, even worse two years.

01:04:00.380 --> 01:04:03.239
So the exciting thing is a solution is the very

01:04:03.239 --> 01:04:05.079
thing that's going to improve everything from

01:04:05.079 --> 01:04:07.719
saving your city money to improving the health

01:04:07.719 --> 01:04:09.860
and relationships of your firefighters and their

01:04:09.860 --> 01:04:13.099
families. It just takes the courage to say. We've

01:04:13.099 --> 01:04:14.699
got to be proactive. Like we're talking about

01:04:14.699 --> 01:04:16.960
the research, you know, the proactive is the

01:04:16.960 --> 01:04:18.599
hardest fight, but it's actually the one that

01:04:18.599 --> 01:04:23.960
makes the most sense. So what about on the chronic

01:04:23.960 --> 01:04:27.159
disease physiologically side? We talked, we touched

01:04:27.159 --> 01:04:28.900
on mental health for a split second. You were

01:04:28.900 --> 01:04:31.519
talking about the impact on the metabolism in

01:04:31.519 --> 01:04:34.840
the rat models. Talk to me about the impact of

01:04:34.840 --> 01:04:37.960
sleep deprivation on, you know, obesity, hypertension,

01:04:38.420 --> 01:04:40.639
diabetes, those kinds of areas that we see so

01:04:40.639 --> 01:04:43.530
prevalent in the fire service. Yeah. And in part,

01:04:43.550 --> 01:04:45.230
it's related to the mental health, right? Like

01:04:45.230 --> 01:04:48.070
if you don't feel as well, you're going to be

01:04:48.070 --> 01:04:51.030
less inclined to go, probably less inclined to

01:04:51.030 --> 01:04:52.909
want to eat a salad, but let alone like prepare

01:04:52.909 --> 01:04:54.590
vegetables and fruits. You just want to find

01:04:54.590 --> 01:04:56.349
something that's not just like quick and easy,

01:04:56.409 --> 01:04:58.489
but going to be quickly satisfying, right? Which

01:04:58.489 --> 01:05:00.989
is going to be like those high dense foods. You're

01:05:00.989 --> 01:05:03.090
going to want more sugar, more fat because those

01:05:03.090 --> 01:05:06.449
and the immediacy feel better. And then there's

01:05:06.449 --> 01:05:08.329
also just like research to show that you don't

01:05:08.329 --> 01:05:11.730
process it well as well as if you're You know,

01:05:11.730 --> 01:05:14.329
eating later at night, whether that's because

01:05:14.329 --> 01:05:16.389
of like circadian timing that your body's not

01:05:16.389 --> 01:05:19.829
set up to process it at that time or just because

01:05:19.829 --> 01:05:24.969
you're up more hours. Yes, you are burning slightly

01:05:24.969 --> 01:05:26.849
more calories because you're up for more amount

01:05:26.849 --> 01:05:29.630
of time, but not to the extent of how much you're

01:05:29.630 --> 01:05:31.289
putting in. Usually you're eating much more,

01:05:31.369 --> 01:05:32.929
especially at that time of night, because, again,

01:05:32.969 --> 01:05:36.010
you're more likely to eat those high dense foods

01:05:36.010 --> 01:05:38.559
than. you know, at 10 o 'clock at night, you're

01:05:38.559 --> 01:05:41.559
not going to go grab a salad. And so over time,

01:05:41.760 --> 01:05:47.460
those things are going to impact, you know, weight

01:05:47.460 --> 01:05:53.079
gain, lipid levels, your ability to process sugar

01:05:53.079 --> 01:05:57.340
leading to diabetes, what have you. Yeah. Yeah.

01:05:57.360 --> 01:05:59.400
I mean, from what I understand as well, like

01:05:59.400 --> 01:06:02.610
sleep deprivation. creates issues with insulin

01:06:02.610 --> 01:06:05.710
so you you know the chances of getting pre -diabetic

01:06:05.710 --> 01:06:08.110
ultimately diabetic are increased you know your

01:06:08.110 --> 01:06:10.090
leptin and ghrelin is all over the place so like

01:06:10.090 --> 01:06:12.090
you said with the hunger and then you know with

01:06:12.090 --> 01:06:15.369
with i mean both sexes especially men the testosterone

01:06:15.369 --> 01:06:17.510
depletion that we've seen with sleep deprivation

01:06:17.510 --> 01:06:21.710
as well exactly and you know the best way to

01:06:21.710 --> 01:06:24.170
you can prevent that by sleeping and so yeah

01:06:24.170 --> 01:06:25.670
people are leaning in on the supplements you

01:06:25.670 --> 01:06:28.130
can't go back once you start that but like you

01:06:28.130 --> 01:06:31.309
can prevent it by by having proper sleep absolutely

01:06:31.309 --> 01:06:34.469
so okay i'll put this to you again because you're

01:06:34.469 --> 01:06:37.190
obviously taking what you've seen and then the

01:06:37.190 --> 01:06:40.809
uh the chronic and um acute effects of this um

01:06:40.809 --> 01:06:45.130
if you gave an extra 24 hours after every 24

01:06:45.130 --> 01:06:49.309
hour shift so you had a 72 hour period what impact

01:06:49.309 --> 01:06:52.630
would that have on the likelihood of obesity

01:06:52.630 --> 01:06:54.610
and some of these other diseases that we've seen

01:06:55.440 --> 01:06:57.880
Yeah. So this is all like speculation based off

01:06:57.880 --> 01:06:59.920
of the research. We haven't we haven't done that

01:06:59.920 --> 01:07:02.019
yet. But yeah, I mean, as long as people are

01:07:02.019 --> 01:07:05.199
actually working to sleep more than eight hours

01:07:05.199 --> 01:07:07.719
to make up for that loss, then, yeah, I could

01:07:07.719 --> 01:07:10.059
say we could reduce those harms. I think part

01:07:10.059 --> 01:07:13.780
of the problem right now is like for all of our

01:07:13.780 --> 01:07:16.360
objective measures of sleep, on average, firefighters

01:07:16.360 --> 01:07:18.739
on their days off are getting about seven hours

01:07:18.739 --> 01:07:20.320
of sleep. That first day off, they'll get about

01:07:20.320 --> 01:07:22.860
seven and a half. So still not, you know, eight,

01:07:22.920 --> 01:07:24.940
nine, which you would hope. you know eight regularly

01:07:24.940 --> 01:07:27.659
nine to make up for that lost sleep and it doesn't

01:07:27.659 --> 01:07:29.380
have to be consecutive right like that's over

01:07:29.380 --> 01:07:32.260
24 hours so take a nap when you get home and

01:07:32.260 --> 01:07:34.280
then try to go to bed a little bit earlier than

01:07:34.280 --> 01:07:37.579
whatever your habitual sleep time is um to get

01:07:37.579 --> 01:07:39.840
so to make up for that right so there's no research

01:07:39.840 --> 01:07:42.420
that's clear on how much additional sleep you

01:07:42.420 --> 01:07:45.400
need to make up for lost sleep but that's only

01:07:45.400 --> 01:07:47.280
because like we haven't had studies where you're

01:07:47.280 --> 01:07:49.800
in the lab for like 48 days to see like When

01:07:49.800 --> 01:07:51.960
we're, again, doing back to the beginning of

01:07:51.960 --> 01:07:54.659
the conversation about some cycles of sleep loss

01:07:54.659 --> 01:07:59.000
versus recovery sleep. But you want to get more

01:07:59.000 --> 01:08:01.280
than the seven to eight. So on your days off,

01:08:01.380 --> 01:08:04.659
you need to find time to get closer to nine that

01:08:04.659 --> 01:08:07.400
first and then eight the others. Because right

01:08:07.400 --> 01:08:09.380
now it's like we see seven and a half on the

01:08:09.380 --> 01:08:11.460
first day and then like six to seven on those

01:08:11.460 --> 01:08:13.800
other days. So some amount of education to make

01:08:13.800 --> 01:08:18.430
sure people are aware. I'd say temporary. you

01:08:18.430 --> 01:08:20.529
know maybe keeping a sleep diary on those days

01:08:20.529 --> 01:08:22.250
off just to like be aware because sometimes people

01:08:22.250 --> 01:08:24.350
are just you're just used to whatever your routine

01:08:24.350 --> 01:08:26.329
is you might not not actually be aware and you're

01:08:26.329 --> 01:08:29.550
so used to being tired that it's it's the same

01:08:29.550 --> 01:08:32.229
right and so um the best way to know like how

01:08:32.229 --> 01:08:35.050
tired you are is if you're on vacation and you

01:08:35.050 --> 01:08:38.390
have any amount of time to sleep are you consistently

01:08:38.390 --> 01:08:40.630
sleeping more than eight hours if so if so like

01:08:40.630 --> 01:08:43.239
you are deprived in sleep and you need to to

01:08:43.239 --> 01:08:45.800
work on that so um i would say if people are

01:08:45.800 --> 01:08:47.619
getting improper sleep on those days off yeah

01:08:47.619 --> 01:08:50.199
i would say we could see a serious um reduction

01:08:50.199 --> 01:08:52.600
in those harms like you and the other thing is

01:08:52.600 --> 01:08:54.180
to get the regularity right so going back to

01:08:54.180 --> 01:08:57.960
not just duration um and how you subjectively

01:08:57.960 --> 01:09:00.039
feel but regularity and i would say firefighters

01:09:00.039 --> 01:09:02.880
or at least those in portland where's where i

01:09:02.880 --> 01:09:05.699
have the most data on that um are somewhat good

01:09:05.699 --> 01:09:08.079
about having like regularity right so that's

01:09:08.079 --> 01:09:10.560
where they're not like nurses maybe who are working

01:09:10.560 --> 01:09:14.659
like purely night or something like that. There's

01:09:14.659 --> 01:09:17.039
some decent amount of consistency. So the sleep

01:09:17.039 --> 01:09:18.720
regularity, we're doing the sleep regularity

01:09:18.720 --> 01:09:21.560
index. It's from zero to 100. Research shows

01:09:21.560 --> 01:09:23.220
if you're like 60 and below, that's where you

01:09:23.220 --> 01:09:25.539
have an increased risk of mental health, chronic

01:09:25.539 --> 01:09:29.760
diseases. And so my firefighters in general are

01:09:29.760 --> 01:09:32.739
about 70. So not perfect. Like I would probably

01:09:32.739 --> 01:09:35.119
be like 95. I'm pretty consistent in my time

01:09:35.119 --> 01:09:37.880
in and out of bed every day. But they're about

01:09:37.880 --> 01:09:41.510
70 because. their mid -sleep time is pretty similar.

01:09:41.810 --> 01:09:43.470
Now, again, that's probably because when they're

01:09:43.470 --> 01:09:44.909
on shift, they should be going to bed a little

01:09:44.909 --> 01:09:46.710
bit earlier. And when they're at home, they should

01:09:46.710 --> 01:09:49.149
be going to bed a little bit earlier. And that

01:09:49.149 --> 01:09:51.010
would really help, I think, to increase both

01:09:51.010 --> 01:09:54.430
that sleep regularity, but also overall duration.

01:09:54.630 --> 01:09:56.409
And I would say with those two things combined,

01:09:56.729 --> 01:09:59.890
we could see improvements in health. What about

01:09:59.890 --> 01:10:03.149
cognitive acuity? You know, we talk about the

01:10:03.149 --> 01:10:05.130
chronic disease element, and that is huge. And

01:10:05.130 --> 01:10:07.789
I mean, I just saw a local firefighter just died

01:10:07.789 --> 01:10:11.250
of cancer yesterday. So that's prevalent front

01:10:11.250 --> 01:10:15.010
and center. But if you look at, again, life safety

01:10:15.010 --> 01:10:18.149
and then also liability. So we're putting a dollar

01:10:18.149 --> 01:10:21.939
amount on a sleep deprived. firefighter whose

01:10:21.939 --> 01:10:24.460
cognition isn't where it should be, you can only

01:10:24.460 --> 01:10:26.720
imagine, you know, the intersection wrecks and

01:10:26.720 --> 01:10:28.479
pushing the wrong medications and intubating

01:10:28.479 --> 01:10:30.819
the esophagus and all the things that are going

01:10:30.819 --> 01:10:32.539
to have, you know, millions of dollars attached

01:10:32.539 --> 01:10:35.640
to it. So what have you seen as far as a relationship

01:10:35.640 --> 01:10:39.000
with sleep deprivation and cognitive acuity in

01:10:39.000 --> 01:10:41.960
whatever professions you were studying? Yeah,

01:10:41.960 --> 01:10:44.039
and that's, I mean, I have stories from like

01:10:44.039 --> 01:10:45.760
nurses that talk about like, I think there was

01:10:45.760 --> 01:10:48.359
one person who noted like they would on their

01:10:48.359 --> 01:10:51.210
way home. And this is where again i think like

01:10:51.210 --> 01:10:52.869
this goes to like the safety culture right if

01:10:52.869 --> 01:10:55.189
you have a culture where it's like okay to take

01:10:55.189 --> 01:10:57.810
a nap before you go home um you could reduce

01:10:57.810 --> 01:10:59.590
these but talking about like you know having

01:10:59.590 --> 01:11:02.310
their hair in a ponytail and having it tied to

01:11:02.310 --> 01:11:04.069
the sunroof so that way if they nod off on their

01:11:04.069 --> 01:11:06.470
sleep they'll feel it right like that's intense

01:11:06.470 --> 01:11:09.430
like the thought process to be like i'd rather

01:11:09.430 --> 01:11:13.670
do that than just pause going home um Or again,

01:11:13.710 --> 01:11:15.750
other ways we could alter schedules to prevent

01:11:15.750 --> 01:11:18.250
something like that altogether happening. But

01:11:18.250 --> 01:11:22.850
yeah, I mean, it is a problem. And the cognitive,

01:11:22.989 --> 01:11:24.729
apart from like the mental health, is a place

01:11:24.729 --> 01:11:26.930
we can see it, right? That's the one nice thing

01:11:26.930 --> 01:11:29.630
about that PVT, that psychomotor vigilant test,

01:11:29.729 --> 01:11:32.050
is that we have all this data from years of in

01:11:32.050 --> 01:11:34.949
-lab work, and now we have field versions of

01:11:34.949 --> 01:11:38.029
it. And so it's a nice way to like compare the

01:11:38.029 --> 01:11:40.010
two, all the years of studies of sleep deprivation

01:11:40.010 --> 01:11:43.050
to the real field. And so, yeah, in the firefighters

01:11:43.050 --> 01:11:47.130
I study, they have a large number of lapses more

01:11:47.130 --> 01:11:49.270
than maybe like the general population that has

01:11:49.270 --> 01:11:52.029
acute levels of sleep deprivation. They consistently

01:11:52.029 --> 01:11:55.590
have really high levels. And so even we see that

01:11:55.590 --> 01:11:58.329
more days are on shift. Those number of lapses

01:11:58.329 --> 01:12:00.989
increase. The more days at home, they decrease.

01:12:02.380 --> 01:12:04.420
on average everyone's doing bad like everyone

01:12:04.420 --> 01:12:06.260
on average is carrying a large amount of sleep

01:12:06.260 --> 01:12:08.119
loss and we would like to see those number of

01:12:08.119 --> 01:12:11.180
lapses in general come down um but yeah just

01:12:11.180 --> 01:12:13.319
yeah there is a large impact and again i just

01:12:13.319 --> 01:12:18.279
i when people are that chronically sleep deprived

01:12:18.279 --> 01:12:20.279
you just don't even realize it right your mind

01:12:20.279 --> 01:12:23.079
plays tricks to like keep you going and so if

01:12:23.079 --> 01:12:25.340
everyone just went on a nice two -week vacation

01:12:25.340 --> 01:12:27.539
and like really slept to see like oh this is

01:12:27.539 --> 01:12:29.260
what it feels like to like get a proper amount

01:12:29.260 --> 01:12:32.680
of sleep um Yeah, I think it could do a lot of

01:12:32.680 --> 01:12:36.020
good. Well, going back to the study that we were

01:12:36.020 --> 01:12:38.220
talking about, it's interesting. I've had Kirk

01:12:38.220 --> 01:12:40.199
Pastey on the show as a Navy SEAL that ended

01:12:40.199 --> 01:12:42.279
up getting into sleep to figure out what was

01:12:42.279 --> 01:12:43.840
going on with his SEALs after he came out of

01:12:43.840 --> 01:12:46.420
med school. And then I think Matthew Walker's

01:12:46.420 --> 01:12:49.460
book quotes this as well, but that 24 hours without

01:12:49.460 --> 01:12:52.279
sleep is like having a blood alcohol of 0 .1.

01:12:53.500 --> 01:12:55.760
And that's, again, if I think about where that

01:12:55.760 --> 01:12:58.189
was studied, it was probably... largely well

01:12:58.189 --> 01:13:00.550
rested college students that were, as you said,

01:13:00.569 --> 01:13:03.329
sleep deprived for a single 24 hours, and they

01:13:03.329 --> 01:13:06.949
got that. So imagine now that times 30 years,

01:13:07.149 --> 01:13:09.489
and then you put in mandatory overtime, what

01:13:09.489 --> 01:13:12.270
blood alcohol are some of our first responders

01:13:12.270 --> 01:13:16.789
really walking around with? Yeah, exactly. So

01:13:16.789 --> 01:13:18.670
yeah, and then I mean, to combine that with like,

01:13:18.829 --> 01:13:20.149
because I don't I mean, you had mentioned about

01:13:20.149 --> 01:13:23.119
I think, like, behaviors, right? But like, alcohol

01:13:23.119 --> 01:13:28.659
use is also very high um on days off and so that's

01:13:28.659 --> 01:13:30.819
preventing again like that nice restorative sleep

01:13:30.819 --> 01:13:33.500
that we need um i know it's like often used as

01:13:33.500 --> 01:13:36.739
like a as a coping mechanism and maybe initially

01:13:36.739 --> 01:13:39.840
as a sleep aid did you fall asleep but the it

01:13:39.840 --> 01:13:42.460
is having consequences on the sleep when um at

01:13:42.460 --> 01:13:45.579
home as well though absolutely just compounding

01:13:45.579 --> 01:13:49.029
it well One thing that came out of Joel's study,

01:13:49.149 --> 01:13:52.729
the 4896, with a department that run less than

01:13:52.729 --> 01:13:56.149
one call a night, so arguably they slept most

01:13:56.149 --> 01:13:59.550
nights, was they saw the benefit of the second

01:13:59.550 --> 01:14:03.050
24 hours of the 48, because the first one, as

01:14:03.050 --> 01:14:07.090
you kind of alluded to earlier, myself included,

01:14:07.310 --> 01:14:09.130
I used to get up at 5 o 'clock in the morning

01:14:09.130 --> 01:14:11.850
to drive 70 miles to go to my station most of

01:14:11.850 --> 01:14:15.279
my career. And he was talking about this, Sarah

01:14:15.279 --> 01:14:17.060
Jenke was talking about this, the prevalence

01:14:17.060 --> 01:14:20.119
of some sort of seed deprivation at the beginning

01:14:20.119 --> 01:14:22.439
of the first shift because of our start times.

01:14:23.279 --> 01:14:27.199
Not instead of, but along with the 24 -72, I

01:14:27.199 --> 01:14:30.659
think changing the start times makes so much

01:14:30.659 --> 01:14:33.239
sense because unlike a lot of jobs, we can turn

01:14:33.239 --> 01:14:36.659
the dial. It's a 24 -hour shift that we work,

01:14:36.760 --> 01:14:38.840
so we can start whenever we want, start and finish.

01:14:39.720 --> 01:14:42.460
in my opinion i think the 11 a .m 12 noon would

01:14:42.460 --> 01:14:46.020
be the absolute sweet spot because the people

01:14:46.020 --> 01:14:48.979
going to shift would actually be able to wake

01:14:48.979 --> 01:14:50.880
up with their family have breakfast take the

01:14:50.880 --> 01:14:53.479
kids to school and then go to the station the

01:14:53.479 --> 01:14:55.699
person who was coming off who got murdered all

01:14:55.699 --> 01:14:59.060
night can actually sleep in a little bit catch

01:14:59.060 --> 01:15:01.159
up on maybe one more sleep cycle and therefore

01:15:01.159 --> 01:15:03.739
make their commute home a lot safer as well.

01:15:04.020 --> 01:15:06.359
So what is your perspective or any science that

01:15:06.359 --> 01:15:09.260
you've seen as far as when we wake up and the

01:15:09.260 --> 01:15:13.359
impact of that on our 24 or 48? Yeah, no, a hundred

01:15:13.359 --> 01:15:17.319
percent. Like the, that is that first, um, that

01:15:17.319 --> 01:15:21.579
first day on, uh, whether it's 24, 48 or the

01:15:21.579 --> 01:15:23.140
one, three, two, three, yeah. Everyone shortens

01:15:23.140 --> 01:15:24.439
their sleep. That is the night they actually

01:15:24.439 --> 01:15:26.260
get the least amount of sleep because they have

01:15:26.260 --> 01:15:29.079
to come on and you know there's people who have

01:15:29.079 --> 01:15:32.180
large commutes from home to their station um

01:15:32.180 --> 01:15:34.420
so yeah we see the same thing and then we also

01:15:34.420 --> 01:15:38.020
see on that second 48 that people are sleeping

01:15:38.020 --> 01:15:41.600
in a bit more um it's like 15 minutes more and

01:15:41.600 --> 01:15:44.060
i think that is something that we could work

01:15:44.060 --> 01:15:48.859
to improve on in part because um on that 48 for

01:15:48.859 --> 01:15:51.180
whatever reason people are also going to before

01:15:51.180 --> 01:15:52.960
that second morning people are still going to

01:15:52.960 --> 01:15:55.460
bed a little bit later um and i think that could

01:15:55.460 --> 01:15:57.579
align with chronotype right like so they're able

01:15:57.579 --> 01:16:00.140
to sleep in or they're going to bit later because

01:16:00.140 --> 01:16:01.680
they're thinking oh i'll be able to sleep and

01:16:01.680 --> 01:16:03.199
i don't have to get up right so i think that's

01:16:03.199 --> 01:16:06.680
just with education and showing them that that's

01:16:06.680 --> 01:16:08.279
what's going on i think we could improve upon

01:16:08.279 --> 01:16:10.500
that and so i think they could there's there

01:16:10.500 --> 01:16:13.380
are a few opportunities when on shift for those

01:16:13.380 --> 01:16:15.960
48 hours if necessary to improve sleep there

01:16:15.960 --> 01:16:18.119
and then just making sure that all stations are

01:16:18.119 --> 01:16:21.020
buying into they don't have to be at 7, 8 a .m.

01:16:21.020 --> 01:16:23.439
or whatever it is for a roll call because we

01:16:23.439 --> 01:16:25.840
did that the prior 24 to make sure there's some

01:16:25.840 --> 01:16:28.359
consistency there. So I think that is an area

01:16:28.359 --> 01:16:30.680
that could be intervened on. And then, yeah,

01:16:30.699 --> 01:16:33.520
more notably, so yeah, I know like, yeah, Sarah

01:16:33.520 --> 01:16:35.600
Jenke's studying that more broadly, the shift

01:16:35.600 --> 01:16:37.520
start time. And I know that Joel has some recent

01:16:37.520 --> 01:16:40.840
outcomes on that. And yeah, I think it's great.

01:16:40.939 --> 01:16:44.380
I had, we like out in Oregon, we had previously,

01:16:44.479 --> 01:16:46.819
we had included those questions, but they hadn't

01:16:46.819 --> 01:16:48.560
thought as far as like 11. It was more like,

01:16:49.039 --> 01:16:50.699
do we want, I think the answer might've been

01:16:50.699 --> 01:16:53.720
like seven, eight, nine, or 10. And most people

01:16:53.720 --> 01:16:56.899
were happy with the like 8am because going to

01:16:56.899 --> 01:16:59.619
those later times, then there is issues with

01:16:59.619 --> 01:17:02.479
like the benefits, I guess we're like not outweighing

01:17:02.479 --> 01:17:05.579
them. in terms of the ability to help with drop

01:17:05.579 --> 01:17:08.039
-offs and things like that, or the ability to

01:17:08.039 --> 01:17:10.340
be home in time for a drop -off or a pickup.

01:17:11.119 --> 01:17:13.159
But I think, yeah, we switched a little bit further

01:17:13.159 --> 01:17:15.420
to the 11 or 12, which I had never even thought

01:17:15.420 --> 01:17:19.039
of until I saw Sarah and Joel's work. But I was

01:17:19.039 --> 01:17:20.720
like, all right, that would get rid of that conflict

01:17:20.720 --> 01:17:26.020
and allow for people to sleep in. Because this

01:17:26.020 --> 01:17:28.619
is a more common question now. I was talking

01:17:28.619 --> 01:17:30.500
to some departments that did more like 5 p .m.

01:17:30.500 --> 01:17:32.420
And I was like, yeah, that could also work. Or

01:17:32.420 --> 01:17:33.779
there was one group that was talking about 7

01:17:33.779 --> 01:17:35.600
p .m. because they could have dinner at home

01:17:35.600 --> 01:17:37.539
and then come in for the transition. And then

01:17:37.539 --> 01:17:39.560
the others would come home and then also have

01:17:39.560 --> 01:17:41.600
time to sleep that night. And I was like, yeah,

01:17:41.640 --> 01:17:43.979
those are all things that are outside of the

01:17:43.979 --> 01:17:46.960
box. And I think get rid of some of those concerns

01:17:46.960 --> 01:17:49.439
around like the 9 or 10 o 'clock, which is what

01:17:49.439 --> 01:17:53.220
I previously saw in discussion. Yeah, because

01:17:53.220 --> 01:17:57.029
when I was reflecting, On the 2448, I only saw

01:17:57.029 --> 01:18:00.289
my family one out of three mornings. And so if

01:18:00.289 --> 01:18:02.010
you change it to this, that would change that

01:18:02.010 --> 01:18:04.850
to two out of three. Or if you did a 2472, three

01:18:04.850 --> 01:18:07.710
out of four. So I love that. And the conversations

01:18:07.710 --> 01:18:09.649
before was always, oh, we'll just do PM then.

01:18:09.810 --> 01:18:11.590
And again, like you said, no one was thinking,

01:18:11.649 --> 01:18:13.649
well, what about in the middle? And it's because

01:18:13.649 --> 01:18:16.710
it kind of smacks against, you know, just the

01:18:16.710 --> 01:18:18.789
way that we've been conditioned. But it really

01:18:18.789 --> 01:18:20.550
does make the most sense. And for me personally,

01:18:20.789 --> 01:18:24.220
if I had to work at 7 p .m. I wouldn't be able

01:18:24.220 --> 01:18:26.039
to enjoy that day because all I'm thinking about

01:18:26.039 --> 01:18:27.880
is I got to go to work. You know, so we already

01:18:27.880 --> 01:18:29.460
want to go out and, you know, have dinner and

01:18:29.460 --> 01:18:30.819
have a glass of wine. No, I can't. I got to go

01:18:30.819 --> 01:18:33.720
to work, you know, versus I still get up. I still

01:18:33.720 --> 01:18:35.680
go technically in the morning to the station

01:18:35.680 --> 01:18:38.300
and I get there. I do my checkout now instead

01:18:38.300 --> 01:18:40.560
of breakfast, it's lunchtime, you know, and then

01:18:40.560 --> 01:18:43.079
conversely, when I go home that next morning,

01:18:43.119 --> 01:18:45.300
because they've got rid of the, you know, the

01:18:45.300 --> 01:18:49.140
roll call kind of wake ups. Now I've stepped

01:18:49.140 --> 01:18:51.119
through and like I said, I've gained sleep there

01:18:51.119 --> 01:18:53.909
too. So, and that's a completely free. All you

01:18:53.909 --> 01:18:56.729
got to do is just get people to buy in. And yes,

01:18:56.829 --> 01:18:59.449
if you did it one way with an 8 a .m. or 7 a

01:18:59.449 --> 01:19:01.090
.m. start, of course, you're going to have to

01:19:01.090 --> 01:19:03.329
figure out things a little bit. But I guarantee

01:19:03.329 --> 01:19:06.329
you, once you get those changes done, you know,

01:19:06.390 --> 01:19:09.109
that extra sleep, like you said, and that reduced

01:19:09.109 --> 01:19:12.010
stress, you know, would be another amplifying

01:19:12.010 --> 01:19:16.500
factor on this health conversation. all right

01:19:16.500 --> 01:19:18.000
well i want to hit one more area and then we'll

01:19:18.000 --> 01:19:21.600
go to some closing questions um thc i saw you

01:19:21.600 --> 01:19:24.399
did a study with that and sleep now i'm a big

01:19:24.399 --> 01:19:29.119
fan of any you know safe plant medicine that

01:19:29.119 --> 01:19:31.000
is going to help someone you know whether it's

01:19:31.000 --> 01:19:33.500
cbd whether it's thc for certain people it's

01:19:33.500 --> 01:19:37.649
not my particular you know jam but I've had Dr.

01:19:37.750 --> 01:19:40.789
Bonnie Goldstein on the show talking about so

01:19:40.789 --> 01:19:44.409
many benefits from THC. What were you finding

01:19:44.409 --> 01:19:47.489
as far as that use and sleep? Because I've heard

01:19:47.489 --> 01:19:50.970
varying stories from some people saying it helps

01:19:50.970 --> 01:19:52.430
with sleep, some people saying it makes sleeps

01:19:52.430 --> 01:19:54.630
worse. So I'd love to hear the actual research

01:19:54.630 --> 01:19:57.930
that you saw. Yeah, so that is the other 50 %

01:19:57.930 --> 01:20:00.210
where I spend my time is on researching cannabis

01:20:00.210 --> 01:20:04.210
and cannabinoids more broadly. So I've also got

01:20:04.210 --> 01:20:08.380
a phase one study. using cbda which is actually

01:20:08.380 --> 01:20:10.680
the precursor to like all these others it's like

01:20:10.680 --> 01:20:14.859
the godmother of cannabinoids um and i'm hopefully

01:20:14.859 --> 01:20:16.880
supposed to have like a nice r01 study starting

01:20:16.880 --> 01:20:19.039
july 1st i haven't gotten the noticeable word

01:20:19.039 --> 01:20:22.680
yet so anxious about that um that'd be to run

01:20:22.680 --> 01:20:25.119
like a really nice large study to look at all

01:20:25.119 --> 01:20:28.100
of this um but from my work right now which is

01:20:28.100 --> 01:20:30.720
like based on epidemiological work i'm looking

01:20:30.720 --> 01:20:33.539
at like thousands of people um those that chronically

01:20:33.539 --> 01:20:37.539
use so that's 16 days or more per month um it

01:20:37.539 --> 01:20:43.199
resulted in um abnormal sleep times, right? But

01:20:43.199 --> 01:20:44.779
we were supposed to get between seven and eight.

01:20:44.819 --> 01:20:47.460
It was resulting in either two, like a little

01:20:47.460 --> 01:20:51.100
less than seven or more than eight. And that

01:20:51.100 --> 01:20:54.619
in part depends on age. But still not in that

01:20:54.619 --> 01:21:00.220
ideal world. And then in our lab studies, where

01:21:00.220 --> 01:21:05.720
they're like under review right now. We run this

01:21:05.720 --> 01:21:07.720
as one of those like in lab studies where we

01:21:07.720 --> 01:21:10.220
were very controlled. So we had people sleep

01:21:10.220 --> 01:21:13.119
habitual schedules before coming in to make sure

01:21:13.119 --> 01:21:16.579
that they were circadian aligned. We had them

01:21:16.579 --> 01:21:19.220
keep a low -fat diet a couple days before coming

01:21:19.220 --> 01:21:24.020
into the lab because THC is lipid based and so

01:21:24.020 --> 01:21:26.119
it would linger more if they previously been

01:21:26.119 --> 01:21:28.619
using and at the same time when we gave them

01:21:28.619 --> 01:21:31.560
THC in the lab we gave it with a high fat snack

01:21:31.560 --> 01:21:36.659
so that way we could try to equal out how it

01:21:36.659 --> 01:21:40.250
was being digested among everybody. And so among

01:21:40.250 --> 01:21:43.590
those that chronically used at home, when we

01:21:43.590 --> 01:21:44.989
were measuring at home with actigraphy before

01:21:44.989 --> 01:21:47.850
they stopped using, we saw that their sleep was,

01:21:48.050 --> 01:21:50.569
they had less sleep on average compared to our

01:21:50.569 --> 01:21:52.850
controls. And then when they came into the lab,

01:21:53.010 --> 01:21:56.289
we didn't see huge differences, but we didn't

01:21:56.289 --> 01:21:59.310
see any benefits. So the idea is that like that

01:21:59.310 --> 01:22:01.090
had kind of been out there is that, well, chronic

01:22:01.090 --> 01:22:03.699
use is bad, which. we've shown but that there's

01:22:03.699 --> 01:22:05.699
still some benefits maybe acutely people could

01:22:05.699 --> 01:22:08.939
use but even in those that had never used when

01:22:08.939 --> 01:22:12.640
they were given a very small small for a regular

01:22:12.640 --> 01:22:14.739
user but like appropriate for a first -time user

01:22:14.739 --> 01:22:18.420
um we didn't see any benefit um some people had

01:22:18.420 --> 01:22:22.600
increased sleep latency um they um the one thing

01:22:22.600 --> 01:22:24.699
we did see which we've other studies have shown

01:22:24.699 --> 01:22:28.489
was that in REM 3, so your slow wave sleep was

01:22:28.489 --> 01:22:31.430
slightly increased. However, we went and looked

01:22:31.430 --> 01:22:35.590
at microsleep architecture, which previous studies

01:22:35.590 --> 01:22:38.109
haven't really looked at. It's like the power

01:22:38.109 --> 01:22:40.430
of your deep sleep. We saw that it started off

01:22:40.430 --> 01:22:43.850
high, but then kind of stayed across the night.

01:22:43.989 --> 01:22:48.229
So the way we're interpreting that is that, yes,

01:22:48.329 --> 01:22:51.140
there is more, slightly more. slow wave sleep

01:22:51.140 --> 01:22:52.640
but that's because the quality isn't as good

01:22:52.640 --> 01:22:54.739
right so your your body's making more of it because

01:22:54.739 --> 01:22:57.079
it's not really working the idea is that this

01:22:57.079 --> 01:22:58.600
delta power in the beginning of the night should

01:22:58.600 --> 01:23:00.399
be high because you've been awake all day so

01:23:00.399 --> 01:23:03.319
you're tired that should once you start sleeping

01:23:03.319 --> 01:23:05.399
that should quickly go away though and we're

01:23:05.399 --> 01:23:07.800
not seeing it go away even with just a small

01:23:07.800 --> 01:23:09.859
amount of cannabis used for the or thc the first

01:23:09.859 --> 01:23:12.420
time we're seeing it just like stay um which

01:23:12.939 --> 01:23:15.579
Often after people do use, the morning they'll

01:23:15.579 --> 01:23:18.300
wake up, they might say, oh, I slept really well,

01:23:18.359 --> 01:23:20.939
but they're still sleepy, right? And so maybe

01:23:20.939 --> 01:23:22.899
that lingering sleepiness is because they didn't

01:23:22.899 --> 01:23:25.279
actually dissipate the thing that's supposed

01:23:25.279 --> 01:23:27.380
to dissipate, the reason why when you wake up,

01:23:27.380 --> 01:23:29.439
you're not supposed to be sleepy. So yeah, so

01:23:29.439 --> 01:23:32.729
we're not seeing any benefit. And so we're trying

01:23:32.729 --> 01:23:36.029
to, that was a small sample. Ideally, we'd like

01:23:36.029 --> 01:23:39.170
to increase that sample and also look at different

01:23:39.170 --> 01:23:41.930
dosing and then mix it with CBD because there's

01:23:41.930 --> 01:23:45.149
always the idea that maybe CBD is attenuating

01:23:45.149 --> 01:23:47.829
some of the negative consequences of THC. Really,

01:23:47.989 --> 01:23:49.409
I think the animal work actually suggests that

01:23:49.409 --> 01:23:52.810
THC is more alerting, or CBD is alerting, but

01:23:52.810 --> 01:23:54.449
we haven't done those types of studies in humans

01:23:54.449 --> 01:23:57.840
yet. What is the research that you found when

01:23:57.840 --> 01:24:01.180
you look into CBD specifically on its own and

01:24:01.180 --> 01:24:04.640
sleep quality? So I haven't studied that yet

01:24:04.640 --> 01:24:07.439
in humans. That is, yeah, a goal moving forward.

01:24:07.520 --> 01:24:09.600
And then the problem with the epidemiological

01:24:09.600 --> 01:24:12.539
world is that no large study is asking that yet.

01:24:12.640 --> 01:24:14.239
And that's even the problem with the cannabis

01:24:14.239 --> 01:24:18.369
use. Is that they're not asking it in a way that

01:24:18.369 --> 01:24:20.189
people are really using. So we published based

01:24:20.189 --> 01:24:22.510
on the epidemiological data. So it was just,

01:24:22.529 --> 01:24:24.510
again, like how many days a month are you using?

01:24:24.590 --> 01:24:27.710
And we do see that people who are using greater

01:24:27.710 --> 01:24:31.090
amounts are having at least poorer sleep durations.

01:24:31.449 --> 01:24:34.489
But yeah, they're not asking about CBD use, let

01:24:34.489 --> 01:24:38.109
alone co -use or anything like that. And yeah,

01:24:38.189 --> 01:24:40.909
so and the research funding is just slowly starting

01:24:40.909 --> 01:24:44.399
to get there. i will say one thing though when

01:24:44.399 --> 01:24:46.659
we like measure blood of people who use cbd levels

01:24:46.659 --> 01:24:50.020
are rather low um so it still is thc is really

01:24:50.020 --> 01:24:52.619
still the predominant um if we're talking about

01:24:52.619 --> 01:24:54.640
like someone who's just smoking it's really is

01:24:54.640 --> 01:24:58.140
thc um and so yeah we haven't yet studied someone

01:24:58.140 --> 01:25:01.039
who's or people who are just you know just taking

01:25:01.039 --> 01:25:03.439
cbd interesting i will say the other thing about

01:25:03.439 --> 01:25:06.340
cbd though and again this is all just me based

01:25:06.340 --> 01:25:08.039
on what i know in the literature and not a study

01:25:08.039 --> 01:25:12.979
i've run but for the things that cbd is like

01:25:12.979 --> 01:25:14.939
fda approved for the studies that have shown

01:25:14.939 --> 01:25:18.619
cbd to work the amounts are much higher than

01:25:18.619 --> 01:25:20.720
what people are getting if they just go to like

01:25:20.720 --> 01:25:24.119
a wellness store or whatnot um so yeah so to

01:25:24.119 --> 01:25:28.100
be aware of that um the dosing isn't really equivalent

01:25:28.100 --> 01:25:30.760
so i guess all that says i sometimes i think

01:25:30.760 --> 01:25:32.859
some of the cbd stuff is placebo but we need

01:25:32.859 --> 01:25:35.340
to run a study to see yeah there's a there's

01:25:35.340 --> 01:25:38.380
a great company rescue one cbd um john for is

01:25:38.380 --> 01:25:40.680
the the creator and he's a firefighter here in

01:25:40.680 --> 01:25:43.840
Florida. And he, I mean, took a big, big, deep,

01:25:43.840 --> 01:25:46.979
excuse me, deep dive into the research and even

01:25:46.979 --> 01:25:48.539
the quality of his product. But he was saying

01:25:48.539 --> 01:25:50.760
the same exact thing. Like there's a lot higher,

01:25:50.840 --> 01:25:54.300
um, strength in the one that he uses. And I've

01:25:54.300 --> 01:25:56.020
actually used his sleep formula and it's got

01:25:56.020 --> 01:25:59.680
the, um, the name just fell out of my head, but

01:25:59.680 --> 01:26:02.140
all, all the elements of lavender and some of

01:26:02.140 --> 01:26:04.180
these other things that we know help with sleep.

01:26:04.649 --> 01:26:07.770
in the, uh, in the actual formulation. And I

01:26:07.770 --> 01:26:09.869
can say for me personally, it helps. And then

01:26:09.869 --> 01:26:12.590
also, um, Ashka Wanda, I've just started taking

01:26:12.590 --> 01:26:14.949
that and that seems to help too. I have a colleague

01:26:14.949 --> 01:26:17.090
who's studying that she's actually has a, like

01:26:17.090 --> 01:26:19.329
a mini panel that she's doing right now on that.

01:26:19.729 --> 01:26:22.390
Yeah. So even that, but so I was taking it and

01:26:22.390 --> 01:26:25.590
at first it seemed like. I don't have to describe

01:26:25.590 --> 01:26:27.689
it. It was almost like a restless mind while

01:26:27.689 --> 01:26:30.130
I was asleep. And then my wife kind of, you know,

01:26:30.130 --> 01:26:32.069
just simple Googling. And she's like, oh, actually,

01:26:32.149 --> 01:26:33.430
a lot of people are saying, don't take it right

01:26:33.430 --> 01:26:35.409
before you go to bed. Take it earlier, you know,

01:26:35.409 --> 01:26:38.050
in the evening. And I shifted that and that helped.

01:26:38.130 --> 01:26:39.550
So just like you're talking about, you know,

01:26:39.630 --> 01:26:42.619
it's these little nuances with these. these studies,

01:26:42.699 --> 01:26:44.539
like nothing is black and white. Like, you know,

01:26:44.560 --> 01:26:46.800
is it going to work at all? Maybe not. Or, you

01:26:46.800 --> 01:26:48.159
know, are you taking it at the wrong time? Or

01:26:48.159 --> 01:26:49.460
did you eat the wrong thing? Yeah, and that's

01:26:49.460 --> 01:26:51.560
why I'm like, oh, again, like back to like the

01:26:51.560 --> 01:26:53.100
firefighters, like we need, especially for the

01:26:53.100 --> 01:26:54.619
cannabis stuff, I think they're just, there's

01:26:54.619 --> 01:26:56.000
a whole lot more research that needs to be done

01:26:56.000 --> 01:26:58.699
because like, whether it's CBD or CBDA, like

01:26:58.699 --> 01:27:00.920
we just don't really actually know. CBD, we know

01:27:00.920 --> 01:27:05.489
more now because of epidiolex and other. uh there's

01:27:05.489 --> 01:27:07.010
been larger clinical studies but all the other

01:27:07.010 --> 01:27:09.050
cannabinoids we know like absolutely very little

01:27:09.050 --> 01:27:11.609
um so we don't even know that proper dosing which

01:27:11.609 --> 01:27:13.449
is why i'm like running this phase one study

01:27:13.449 --> 01:27:16.869
um but it's just like it's all it's all out there

01:27:16.869 --> 01:27:19.229
let alone like the best timing of use the best

01:27:19.229 --> 01:27:21.449
should you i mean obviously if it's gonna be

01:27:21.449 --> 01:27:23.210
medically prescribed no one's gonna say you should

01:27:23.210 --> 01:27:25.550
smoke it but um but then we actually need to

01:27:25.550 --> 01:27:27.649
have more studies on the oral for uh formulations

01:27:27.649 --> 01:27:32.369
um yeah yeah it is yeah it's interesting it's

01:27:32.369 --> 01:27:36.479
also challenging because like yeah this like

01:27:36.479 --> 01:27:38.359
the uses patterns of like that you're you know

01:27:38.359 --> 01:27:40.260
often people are going to like drink and do that

01:27:40.260 --> 01:27:42.340
or something like that right so like define populations

01:27:42.340 --> 01:27:46.920
that are clean to study just uh cannabis uses

01:27:46.920 --> 01:27:50.439
is also a challenge but so what do you use personally

01:27:50.439 --> 01:27:52.539
with all this background in sleep and you know

01:27:52.539 --> 01:27:54.979
studying some of these supplementations now what

01:27:54.979 --> 01:27:57.239
is your kind of sleep routine in the evening

01:27:57.239 --> 01:28:01.739
yeah i I think regularity is like what I use

01:28:01.739 --> 01:28:04.880
the most. So like I will have like a cup of coffee

01:28:04.880 --> 01:28:07.319
in the morning and then very rarely will I have

01:28:07.319 --> 01:28:09.520
anything after lunch. So that's probably what

01:28:09.520 --> 01:28:13.079
I do the best. I try to get daylight, like make

01:28:13.079 --> 01:28:14.939
sure I'm getting lots of sun during the day and

01:28:14.939 --> 01:28:16.979
being here in the Pacific Northwest in the winter,

01:28:17.039 --> 01:28:19.079
that's hard, but I make sure I go on like a walk

01:28:19.079 --> 01:28:20.859
for at least an hour during the day to make sure

01:28:20.859 --> 01:28:23.260
I'm getting light during the day. And then at

01:28:23.260 --> 01:28:26.100
night, yeah, once like I have a three -year -old

01:28:26.100 --> 01:28:28.220
and a seven -year -old and like once we... Getting

01:28:28.220 --> 01:28:30.340
into that nighttime routine, like lights are

01:28:30.340 --> 01:28:33.560
red. And even in their bathroom, the light is

01:28:33.560 --> 01:28:35.060
red. So they have to get up in the middle of

01:28:35.060 --> 01:28:36.420
the night. They're not getting exposed to light

01:28:36.420 --> 01:28:38.939
at night. So in like our bedroom, we have like

01:28:38.939 --> 01:28:41.800
red lights at night. So yeah, so I reduce light

01:28:41.800 --> 01:28:43.380
at night, make sure I'm getting light in the

01:28:43.380 --> 01:28:47.699
morning, reduce caffeine, you know, try to keep

01:28:47.699 --> 01:28:50.439
alcohol to a minimal, especially in the evening.

01:28:50.460 --> 01:28:51.840
I'm actually like more of someone who would.

01:28:52.220 --> 01:28:54.319
have it at brunch or lunch then later in the

01:28:54.319 --> 01:28:57.159
day let my body process it during the day so

01:28:57.159 --> 01:29:01.800
it doesn't disturb sleep um yeah and then try

01:29:01.800 --> 01:29:04.439
to keep a cool i do like the summer's been harder

01:29:04.439 --> 01:29:06.520
um but yeah i keep a cool bedroom but then i'm

01:29:06.520 --> 01:29:08.439
also like someone who likes like a heated mattress

01:29:08.439 --> 01:29:11.779
though because i feel like that helps like peripherally

01:29:11.779 --> 01:29:13.720
dissipate energy so your core body temperature

01:29:13.720 --> 01:29:17.989
can reduce um that's the other thing i do There's

01:29:17.989 --> 01:29:19.170
something actually just while you're sitting

01:29:19.170 --> 01:29:21.550
in the Northwest talking about the winters. I

01:29:21.550 --> 01:29:22.850
was thinking about this the other day. I'm in

01:29:22.850 --> 01:29:26.449
Florida. So our summer days are extremely bright,

01:29:26.550 --> 01:29:29.810
extremely long, from 6 a .m. to like 9 p .m.

01:29:29.810 --> 01:29:33.770
basically or 5 .30 even. And I was thinking when

01:29:33.770 --> 01:29:36.550
we're talking about the chronoreceptors, obviously

01:29:36.550 --> 01:29:39.970
there must be an expanding and contracting element

01:29:39.970 --> 01:29:42.489
to the circadian rhythm throughout the year.

01:29:43.239 --> 01:29:46.500
So what have you found as far as that? And then

01:29:46.500 --> 01:29:49.260
the impact of being someone like the you living

01:29:49.260 --> 01:29:51.739
somewhere like the UK or the Pacific Northwest,

01:29:52.060 --> 01:29:54.979
where maybe you don't, you know, have those those

01:29:54.979 --> 01:29:57.500
long days like someone, you know, closest to

01:29:57.500 --> 01:30:00.880
the equator like I am. Yeah, so like in terms

01:30:00.880 --> 01:30:03.500
of the seasonality, I haven't so I, I always

01:30:03.500 --> 01:30:05.180
record it and all my stuff, even the firefighter

01:30:05.180 --> 01:30:08.300
stuff, I record it and in part because it's behaviors

01:30:08.300 --> 01:30:10.180
are very different. Like everyone's camping out

01:30:10.180 --> 01:30:12.680
here in the summertime. And so they're getting

01:30:12.680 --> 01:30:15.579
more light just from that. It's been something

01:30:15.579 --> 01:30:18.220
that I'm aware that I account for, so I account

01:30:18.220 --> 01:30:21.300
for month in all of my analysis. We actually

01:30:21.300 --> 01:30:23.359
are starting to do some, not in the firefighters,

01:30:23.500 --> 01:30:26.220
but with my canvas work, actually measuring the

01:30:26.220 --> 01:30:28.819
ability to suppress melatonin. That's as far

01:30:28.819 --> 01:30:34.520
as that goes, but in terms of what I do, as much

01:30:34.520 --> 01:30:36.880
as I'm saying, okay, we'll do red lights at night.

01:30:37.560 --> 01:30:40.300
We will also use blue lights in the morning and

01:30:40.300 --> 01:30:45.220
the winter because our days are extremely short

01:30:45.220 --> 01:30:50.340
out here. I'm outside, but what is the lux exposure

01:30:50.340 --> 01:30:52.920
we're actually getting? It's rather low probably.

01:30:54.420 --> 01:30:57.699
I account for the lux exposure. Even in my lab

01:30:57.699 --> 01:31:00.560
studies, a lot of the canvas work we did was

01:31:00.560 --> 01:31:02.380
in dim lighting because we were just controlling

01:31:02.380 --> 01:31:06.020
for that. And so, yeah, so I'm aware of it. I

01:31:06.020 --> 01:31:08.079
control for it or I modulate it. But in terms

01:31:08.079 --> 01:31:11.699
of like, yeah, I don't know if I'm like fully

01:31:11.699 --> 01:31:14.220
answering the question. Yeah, I just it was interesting

01:31:14.220 --> 01:31:16.420
because if you took a Floridian and someone from

01:31:16.420 --> 01:31:19.079
Portland and then you again did a air quote study,

01:31:19.279 --> 01:31:21.500
you know, that obviously they would be in completely

01:31:21.500 --> 01:31:23.460
different places. So even where you're standing

01:31:23.460 --> 01:31:25.979
on the planet is going to impact your circadian

01:31:25.979 --> 01:31:28.579
rhythm. And I would I would assume even the length

01:31:28.579 --> 01:31:31.619
of your sleep night. Yeah, so it's like something

01:31:31.619 --> 01:31:33.779
that in that and temperature are things that

01:31:33.779 --> 01:31:36.020
I'm increasingly starting to collect because

01:31:36.020 --> 01:31:38.000
it is an interest. And I've been thinking about

01:31:38.000 --> 01:31:40.880
that as well. Well, one quick thing, because

01:31:40.880 --> 01:31:42.260
I remember when I was looking at some of the

01:31:42.260 --> 01:31:44.199
studies you've done, some of them were specifically

01:31:44.199 --> 01:31:47.479
regarding black people. So what caused you to

01:31:47.479 --> 01:31:49.260
kind of lean into that? And what were some of

01:31:49.260 --> 01:31:53.159
the findings as far as an actual ethnic population

01:31:53.159 --> 01:31:55.199
and some of the health outcomes that you were

01:31:55.199 --> 01:31:57.600
studying? Yeah. So then that was going back to

01:31:57.600 --> 01:31:59.619
like talking about like diversifying our studies.

01:31:59.680 --> 01:32:01.600
And I was mentioning like, oh, we have satin,

01:32:01.600 --> 01:32:05.260
you know, quals or things like that. And part

01:32:05.260 --> 01:32:07.140
of it was to diversify the studies. Right. So

01:32:07.140 --> 01:32:08.439
one of the some of the outcomes we were looking

01:32:08.439 --> 01:32:11.500
at were, again, going back to the blood pressure.

01:32:11.560 --> 01:32:13.720
Right. So the non -dipping blood pressure is

01:32:13.720 --> 01:32:16.260
more prevalent among African -Americans. But

01:32:16.260 --> 01:32:17.760
those aren't the populations we're studying it

01:32:17.760 --> 01:32:19.680
in. Right. So we were studying the question we

01:32:19.680 --> 01:32:23.020
have. if the outcomes are related to that we

01:32:23.020 --> 01:32:24.960
should be making sure they're included in our

01:32:24.960 --> 01:32:27.060
studies we had done like a review one of the

01:32:27.060 --> 01:32:29.260
first things i did when i joined i came here

01:32:29.260 --> 01:32:31.739
to work um we were looking at the timing of blood

01:32:31.739 --> 01:32:34.819
pressure medications the number of african americans

01:32:34.819 --> 01:32:37.819
in those studies were so so low but that is the

01:32:37.819 --> 01:32:39.500
population that is most prevalent not only most

01:32:39.500 --> 01:32:41.840
prevalent but at earlier ages like you know talking

01:32:41.840 --> 01:32:44.949
about late 20s early 30s having hypertension

01:32:44.949 --> 01:32:46.770
but they're not part of the studies right so

01:32:46.770 --> 01:32:49.909
that's that became the rationale there and again

01:32:49.909 --> 01:32:52.229
like why I spent quite a bit of my time actually

01:32:52.229 --> 01:32:55.630
doing like community work because so I also started

01:32:55.630 --> 01:32:56.949
this talking about how like I'm up on a hill

01:32:56.949 --> 01:33:02.289
OHSU we're the only medical college in Oregon

01:33:02.289 --> 01:33:04.550
and one of the few in the Pacific Northwest there's

01:33:04.550 --> 01:33:10.689
like three so we we have a large spread but people

01:33:10.689 --> 01:33:12.069
don't necessarily like to come up here, right?

01:33:12.149 --> 01:33:16.350
It is out of the way. And so it takes work to

01:33:16.350 --> 01:33:18.850
get off our hill, to communicate the research,

01:33:18.930 --> 01:33:22.310
to build the trust, to get people here and, you

01:33:22.310 --> 01:33:24.510
know, do all that work. And the numbers are so

01:33:24.510 --> 01:33:27.050
small that we're able to get here, but it's important.

01:33:27.810 --> 01:33:29.970
So, so yeah, so that's the rationale of doing

01:33:29.970 --> 01:33:33.449
it. But then also going back to like the comments

01:33:33.449 --> 01:33:35.289
we had, so it's nice for coming full circle.

01:33:35.329 --> 01:33:36.930
It's not just genetics, right? Like the reasons

01:33:36.930 --> 01:33:40.239
why oftentimes that African -Americans have these

01:33:40.239 --> 01:33:43.359
outcomes are because of, like in Portland, for

01:33:43.359 --> 01:33:45.119
example, there's a large history of redlining.

01:33:45.279 --> 01:33:50.199
And so there's just generational trauma that

01:33:50.199 --> 01:33:52.880
has been present. And also the reason why there's

01:33:52.880 --> 01:33:57.140
mistrust with organizations like OHSU. And so

01:33:57.140 --> 01:33:59.279
it takes time to break those things down, but

01:33:59.279 --> 01:34:01.159
also have to measure those things, right? And

01:34:01.159 --> 01:34:03.699
so we have a lot of measures of stress in the

01:34:03.699 --> 01:34:06.560
lab. And so what we've analyzed right now isn't...

01:34:06.890 --> 01:34:09.529
Based on race, it's based more on stress. And

01:34:09.529 --> 01:34:13.010
so we look at people who have a history of stress.

01:34:14.149 --> 01:34:15.869
We can measure that in a few different ways,

01:34:15.930 --> 01:34:18.229
but it's more like we have this measure of cumulative

01:34:18.229 --> 01:34:20.710
stress over one's lifetime. And we can see that

01:34:20.710 --> 01:34:23.310
those that have larger amounts of stress have

01:34:23.310 --> 01:34:28.420
blunted. it can go both ways where you can have

01:34:28.420 --> 01:34:32.340
like a magnified, but this are outcomes we've

01:34:32.340 --> 01:34:34.399
had for some of these circadian measures. So

01:34:34.399 --> 01:34:36.000
if we look at like the circadian rhythm of cortisol,

01:34:36.159 --> 01:34:40.239
it's blunted. And so the consequences of that,

01:34:40.300 --> 01:34:42.859
we're not sure yet where we have some other measures

01:34:42.859 --> 01:34:45.460
that we're still seeking to look like inflammation

01:34:45.460 --> 01:34:47.899
and things like that. But we know that it is.

01:34:48.329 --> 01:34:50.390
abnormal response and not just baseline but if

01:34:50.390 --> 01:34:51.989
you actually then stress someone out further

01:34:51.989 --> 01:34:55.630
with um in the lab we do like this mental math

01:34:55.630 --> 01:34:57.369
test and then you also have to put your hand

01:34:57.369 --> 01:35:00.770
in cold water so like a very robust model we

01:35:00.770 --> 01:35:02.909
see that it's just they have a blunted response

01:35:02.909 --> 01:35:05.729
to that as well um so that could be it's not

01:35:05.729 --> 01:35:09.090
a negative thing right sometimes um your body

01:35:09.090 --> 01:35:11.630
adapts and so the adaptive response to having

01:35:11.630 --> 01:35:14.170
a cumulative stress in your life is having smaller

01:35:14.170 --> 01:35:16.789
responses to an acute stress um but that could

01:35:16.789 --> 01:35:19.430
also be detrimental right if you if you're waking

01:35:19.430 --> 01:35:21.649
up right because even just waking up is a stress

01:35:21.649 --> 01:35:24.930
to our body you're going from supine sleep to

01:35:24.930 --> 01:35:28.569
having to um you know get all the muscles moving

01:35:28.569 --> 01:35:30.989
and in order to stand up to order to think to

01:35:30.989 --> 01:35:34.329
order to go get a meal of our hunter -gatherers

01:35:34.329 --> 01:35:36.310
right making sure we're having all those things

01:35:36.310 --> 01:35:39.270
necessary to start our day and get energy to

01:35:39.270 --> 01:35:43.220
keep us going um you maybe need a bigger response

01:35:43.220 --> 01:35:47.699
rate to hit external demands that are coming

01:35:47.699 --> 01:35:50.840
out. So it could be adaptive in the short term,

01:35:50.859 --> 01:35:54.039
but could be harmful in the long term. So we

01:35:54.039 --> 01:35:56.220
don't have like definitive outcomes. We do see

01:35:56.220 --> 01:36:00.000
that there is an irregularity going on. And we're

01:36:00.000 --> 01:36:02.260
still trying to further see how that could be

01:36:02.260 --> 01:36:04.199
impacting blood pressure and the inability for

01:36:04.199 --> 01:36:06.800
some to have their blood pressure drop at night.

01:36:07.579 --> 01:36:10.659
When you say redlining, explain to me what that

01:36:10.659 --> 01:36:17.689
is. So so there was so it's these old maps for

01:36:17.689 --> 01:36:20.350
like like housing and like the pricing of housing.

01:36:20.470 --> 01:36:24.189
Right. And so they would have this is where I'm

01:36:24.189 --> 01:36:26.069
like, I'm not defining it the best, but essentially

01:36:26.069 --> 01:36:29.289
there would be there would have like this is

01:36:29.289 --> 01:36:30.810
where people should live. And like these would

01:36:30.810 --> 01:36:32.949
be the prices of these houses. And so it pretty

01:36:32.949 --> 01:36:35.260
much like. resulted in the African -American

01:36:35.260 --> 01:36:37.279
community here living in some places and the

01:36:37.279 --> 01:36:39.060
inability of them to live in places that would

01:36:39.060 --> 01:36:41.659
be more desirable. And that would, again, help

01:36:41.659 --> 01:36:43.819
build that generational wealth, right? If they're

01:36:43.819 --> 01:36:46.119
not able to buy the houses in the nicer areas

01:36:46.119 --> 01:36:50.520
that have better resale values, then when they

01:36:50.520 --> 01:36:52.600
pass away, they're not able to pass that on to

01:36:52.600 --> 01:36:55.460
their children, right? And so then, yeah, so

01:36:55.460 --> 01:37:00.569
it's just a way of propagating. And actually,

01:37:00.609 --> 01:37:02.369
there was like a recent thing out here in Portland

01:37:02.369 --> 01:37:04.170
where there was something similar. So in Facebook,

01:37:04.510 --> 01:37:07.770
you could like for advertising, for example,

01:37:07.810 --> 01:37:10.750
you could. And I honestly, I would use some of

01:37:10.750 --> 01:37:13.250
these things to help recruit diverse populations.

01:37:13.289 --> 01:37:15.850
And so you could use I think you could just say

01:37:15.850 --> 01:37:18.649
you were interested in the higher black population,

01:37:18.770 --> 01:37:20.689
but you could also then say you weren't. And

01:37:20.689 --> 01:37:25.100
so even right now, there is a company for. I

01:37:25.100 --> 01:37:26.239
don't know if it was apartments or whatever,

01:37:26.380 --> 01:37:28.560
but they were purposely trying to not advertise

01:37:28.560 --> 01:37:33.100
to black individuals. And so in Facebook, you're

01:37:33.100 --> 01:37:37.300
no longer able to do that. And it was because

01:37:37.300 --> 01:37:39.140
of like that reason. So that's like a modern

01:37:39.140 --> 01:37:41.119
day version of redlining. You're keeping certain

01:37:41.119 --> 01:37:45.239
populations out of certain residential areas.

01:37:46.239 --> 01:37:48.420
yeah well facebook's anyway i can tell you that

01:37:48.420 --> 01:37:51.960
way yes yes because older people still use it

01:37:51.960 --> 01:37:54.000
so for certain studies it is a good advertising

01:37:54.000 --> 01:37:57.420
tool and so it's like a way to get messages out

01:37:57.420 --> 01:37:59.979
there but but yes yeah agreed well i can tell

01:37:59.979 --> 01:38:01.720
you they've redlined james geary because i have

01:38:01.720 --> 01:38:04.479
30 000 people on the behind the shield one and

01:38:04.479 --> 01:38:08.199
then like 5 000 on the personal one and i will

01:38:08.199 --> 01:38:10.680
do a post and most of my posts are about you

01:38:10.680 --> 01:38:12.979
know solutions and advertising the podcast and

01:38:12.979 --> 01:38:15.569
all that stuff I'll be lucky if I get five people

01:38:15.569 --> 01:38:18.250
that have seen it. I mean, genuinely. So that

01:38:18.250 --> 01:38:20.869
algorithm again, and that's probably less about

01:38:20.869 --> 01:38:23.170
my skin color and more about forcing me to pay

01:38:23.170 --> 01:38:26.510
for people to see the page. But it's, you know,

01:38:26.510 --> 01:38:29.010
it's again. It is sometimes because I, yeah,

01:38:29.050 --> 01:38:33.289
like there's another podcast I follow where they

01:38:33.289 --> 01:38:35.279
were talking about that on Twitter. shadow banned

01:38:35.279 --> 01:38:37.880
that's the tool that's the term for that um they

01:38:37.880 --> 01:38:39.859
used to have like everything would be retweeted

01:38:39.859 --> 01:38:41.420
a whole bunch and then they they said something

01:38:41.420 --> 01:38:43.739
and then like now no one no one sees what they

01:38:43.739 --> 01:38:46.720
they write anymore um and they pay in part because

01:38:46.720 --> 01:38:49.199
they were like because they're like they were

01:38:49.199 --> 01:38:51.159
shadow banned um but there's still like a level

01:38:51.159 --> 01:38:54.600
that those companies are able to have some say

01:38:54.600 --> 01:38:57.720
yeah yeah exactly well going back to you know

01:38:57.720 --> 01:39:00.760
your point we're making with with redlining This

01:39:00.760 --> 01:39:02.819
is another thing I just finished writing a book

01:39:02.819 --> 01:39:04.460
the very end of last year, and I'm going to make

01:39:04.460 --> 01:39:06.380
it into a show. But that multi -generational

01:39:06.380 --> 01:39:08.819
trauma, you know, whether it is autoimmune disease,

01:39:08.960 --> 01:39:11.399
whether it's cancer, I mean, it's stress that's

01:39:11.399 --> 01:39:13.800
passed on from generation to generation. And

01:39:13.800 --> 01:39:15.560
then hearing about all the things that you've

01:39:15.560 --> 01:39:18.279
talked about today, the impact of stress, especially

01:39:18.279 --> 01:39:21.060
chronically from a young child all the way through

01:39:21.060 --> 01:39:24.680
to 40s, 50s, you know, you don't have to be a

01:39:24.680 --> 01:39:26.600
genius. Then you add on environmental stress.

01:39:26.659 --> 01:39:29.159
And obviously, you know, if you're growing up

01:39:29.159 --> 01:39:31.149
in a place where you're not, Your environment

01:39:31.149 --> 01:39:33.590
didn't allow you to understand movement and understand

01:39:33.590 --> 01:39:35.770
what good food looks like. And then, you know,

01:39:35.789 --> 01:39:38.090
we wonder why we have not only obesity and heart

01:39:38.090 --> 01:39:40.750
disease, but also the cancers. So, I mean, you

01:39:40.750 --> 01:39:43.510
know, again, going back to that proactive conversation,

01:39:43.930 --> 01:39:46.569
the more we unpack all this, the more we get

01:39:46.569 --> 01:39:48.930
to the, you know, the root causes again. And

01:39:48.930 --> 01:39:51.289
I would argue a lot of the science is going to

01:39:51.289 --> 01:39:53.029
show, well, hey, if we lived like we did 100

01:39:53.029 --> 01:39:56.470
plus years ago, we're going to eliminate 80 %

01:39:56.470 --> 01:40:02.909
of, you know, diseases by that point. Yeah. All

01:40:02.909 --> 01:40:04.770
right. Well, the first of the closing questions,

01:40:04.970 --> 01:40:07.649
is there a book or are there books that you'd

01:40:07.649 --> 01:40:10.229
love to recommend? It can be related to our discussion

01:40:10.229 --> 01:40:15.689
today or completely unrelated. No, I am not good

01:40:15.689 --> 01:40:18.409
with like book recommendations at all. No, I'm

01:40:18.409 --> 01:40:21.670
trying to, again, I'm between like trying to

01:40:21.670 --> 01:40:24.109
write grants and all of that. I'm, I'm trying

01:40:24.109 --> 01:40:26.350
to increase my writing, my reading, but when

01:40:26.350 --> 01:40:30.479
I choose like a book, I, um, yeah, it's gonna,

01:40:30.539 --> 01:40:32.640
it's, it's more like fantastical. So I'm like

01:40:32.640 --> 01:40:35.760
right now reading a book, um, on Walt Disney.

01:40:35.979 --> 01:40:39.199
Uh, so yeah, not related to research at all,

01:40:39.239 --> 01:40:42.460
but it's been, yeah. So it's fun to be something

01:40:42.460 --> 01:40:44.340
completely different. So yeah, no, I'm not good

01:40:44.340 --> 01:40:47.699
with book recommendations. What about, um, films

01:40:47.699 --> 01:40:53.100
or documentaries then? Uh, no, I'm not good at

01:40:53.100 --> 01:40:54.920
that either. Yeah. It's interesting when people,

01:40:55.079 --> 01:40:59.149
um, When they're curious, like if they're interested

01:40:59.149 --> 01:41:00.810
in sleep, like I will point them to, I think

01:41:00.810 --> 01:41:02.550
like the American Academy of Sleep Medicine has

01:41:02.550 --> 01:41:06.689
started to build a very nice repository, a podcast.

01:41:06.829 --> 01:41:11.350
And they're all like researchers that I don't

01:41:11.350 --> 01:41:12.529
necessarily personally know, but I know their

01:41:12.529 --> 01:41:15.930
work and their body of research. And I know it's

01:41:15.930 --> 01:41:20.149
like good stuff. So I often point to that. And

01:41:20.149 --> 01:41:22.810
then at one point, at least like the NIH had,

01:41:23.010 --> 01:41:28.319
so they. within the national institute of heart

01:41:28.319 --> 01:41:31.720
and blood lung diseases um they have like a sleep

01:41:31.720 --> 01:41:34.760
repository or sleep center and so they have a

01:41:34.760 --> 01:41:36.859
lot of great resources on there that i will also

01:41:36.859 --> 01:41:39.060
point people to including like on youtube they'll

01:41:39.060 --> 01:41:41.659
have um talks that have been given by different

01:41:41.659 --> 01:41:45.020
sleep researchers uh as well as um they have

01:41:45.020 --> 01:41:48.239
like um a couple of like There are like PDF books

01:41:48.239 --> 01:41:50.380
you could print out or like sleep chapters that

01:41:50.380 --> 01:41:52.600
give a nice overview on sleep health. So, yeah,

01:41:52.619 --> 01:41:54.600
that's I think people ask those are usually the

01:41:54.600 --> 01:41:57.380
places I point them to. Perfect. All right. Well,

01:41:57.399 --> 01:41:59.359
the next question, speaking of people, is there

01:41:59.359 --> 01:42:01.399
a person that you'd recommend to come on this

01:42:01.399 --> 01:42:04.439
podcast as a guest to speak to the first responders,

01:42:04.539 --> 01:42:06.819
military and associated professions of the world?

01:42:08.539 --> 01:42:10.800
Well, you've already spoke to Joel and Sarah.

01:42:10.939 --> 01:42:12.539
So those are the people that I would probably

01:42:12.539 --> 01:42:17.500
point to. You know, I think, so I have a colleague

01:42:17.500 --> 01:42:20.960
here, Leslie Hammer. I'm curious if she'd be

01:42:20.960 --> 01:42:22.739
interested in speaking, but she comes at it.

01:42:22.760 --> 01:42:25.420
She's worked with the National Guard and she

01:42:25.420 --> 01:42:27.239
does a lot of research on like supervisor support

01:42:27.239 --> 01:42:31.579
and including sleep support. So still like first

01:42:31.579 --> 01:42:34.260
responder in nature, but not firefighters specifically.

01:42:34.300 --> 01:42:36.779
But yeah, she comes very much from a supervisor

01:42:36.779 --> 01:42:40.000
support and the importance there. And also she

01:42:40.000 --> 01:42:43.470
also, so I. Because we're a NIOSH -funded center,

01:42:43.670 --> 01:42:46.789
we lean in on their total worker health approach.

01:42:46.970 --> 01:42:49.750
So that's another way of really noting a multi

01:42:49.750 --> 01:42:52.970
-level approach. So recognizing that if you can

01:42:52.970 --> 01:42:56.289
create change on the organizational level, you'll

01:42:56.289 --> 01:42:58.789
have the largest impact. But there's also a role

01:42:58.789 --> 01:43:01.050
for environmental changes in engineering and

01:43:01.050 --> 01:43:05.569
personal level, whether that's thinking about

01:43:05.569 --> 01:43:08.590
just PPE, which is important, but that's only

01:43:08.590 --> 01:43:13.529
impacting one person. And then also like behavioral

01:43:13.529 --> 01:43:16.170
change as well. So yeah, I think she could actually

01:43:16.170 --> 01:43:18.270
be interesting and just from a slightly different

01:43:18.270 --> 01:43:21.130
point of view. Brilliant. Well, thank you. All

01:43:21.130 --> 01:43:22.649
right. Well, the very last question before we

01:43:22.649 --> 01:43:24.890
make sure everyone knows where to find you, what

01:43:24.890 --> 01:43:29.810
do you do to decompress? A lot of those hour

01:43:29.810 --> 01:43:31.430
long walks I was talking about during the day.

01:43:31.550 --> 01:43:34.010
So yeah, if I'm ever like at a, and I might break

01:43:34.010 --> 01:43:36.109
those up in like 15 minute walks. So if I am

01:43:36.109 --> 01:43:37.390
ever at a point where I'm like, you know, I've

01:43:37.390 --> 01:43:39.680
been staring at a screen and I'm, you know i'm

01:43:39.680 --> 01:43:41.279
not like actually paying attention to the words

01:43:41.279 --> 01:43:42.899
that i'm reading or i'm not able to write like

01:43:42.899 --> 01:43:45.000
i will just get up and i will go for a walk i

01:43:45.000 --> 01:43:48.119
love spin classes um because especially well

01:43:48.119 --> 01:43:50.279
it has to have good music but not all teachers

01:43:50.279 --> 01:43:52.579
do but when it's a good class like i am completely

01:43:52.579 --> 01:43:55.500
able to detach because i can just listen to the

01:43:55.500 --> 01:43:59.060
music and and go fast um and then i mean the

01:43:59.060 --> 01:44:01.600
summers out here in the pacific northwest are

01:44:01.600 --> 01:44:05.819
just amazing and so every weekend we're if the

01:44:05.819 --> 01:44:08.239
weather's if it's warm enough we're on the water

01:44:08.239 --> 01:44:11.180
you know kayaking or paddle boarding um and then

01:44:11.180 --> 01:44:13.000
my kids are just the best on the sand as well

01:44:13.000 --> 01:44:14.319
because it's like a babysitter they can just

01:44:14.319 --> 01:44:17.220
like build all day long and they're happy um

01:44:17.220 --> 01:44:20.279
or we're picking fruit like i just did not realize

01:44:20.279 --> 01:44:23.079
how many kinds of blackberries there were when

01:44:23.079 --> 01:44:25.479
i moved out here like there's tea berries and

01:44:25.479 --> 01:44:27.920
marion berries and um and then there's like a

01:44:27.920 --> 01:44:30.279
cherry season and so we have all the things so

01:44:30.279 --> 01:44:32.220
yeah i love to go fruit picking out here in the

01:44:32.220 --> 01:44:34.930
summer as well beautiful all right well if people

01:44:34.930 --> 01:44:37.109
do want to reach out learn more about you where

01:44:37.109 --> 01:44:40.590
are the best places online um so you can email

01:44:40.590 --> 01:44:43.510
our um our you can either email me personally

01:44:43.510 --> 01:44:47.369
at bowls my last name n as a nicole at ohsu .edu

01:44:47.369 --> 01:44:52.189
um or our lab account which is circadian um at

01:44:52.189 --> 01:44:56.020
ohsu .edu Brilliant. Well, I want to thank you

01:44:56.020 --> 01:44:58.399
so much. I mean, this is, it's always a different

01:44:58.399 --> 01:45:00.699
perspective because you're coming from a research

01:45:00.699 --> 01:45:02.600
lens, you know, and then obviously I'm talking

01:45:02.600 --> 01:45:05.460
about being inside the bunker gear, but all these

01:45:05.460 --> 01:45:07.479
layers are just so important to tell the whole

01:45:07.479 --> 01:45:09.779
story. And some of the things that you've already

01:45:09.779 --> 01:45:11.399
researched, some of the things that you're proposing

01:45:11.399 --> 01:45:13.279
to research, especially the THC, for example,

01:45:13.420 --> 01:45:16.340
has been so, so valuable for everyone to hear.

01:45:16.420 --> 01:45:18.300
So I want to thank you so, so much for being

01:45:18.300 --> 01:45:20.260
so generous with your time and coming on the

01:45:20.260 --> 01:45:22.949
Behind the Shield podcast today. Thank you. Thanks

01:45:22.949 --> 01:45:27.310
for having me. I think it's so important to get

01:45:27.310 --> 01:45:32.609
outside of the walls of academia. One, to share

01:45:32.609 --> 01:45:34.649
the knowledge that we've generated with American

01:45:34.649 --> 01:45:37.550
taxpayer dollars. But because I learned so much

01:45:37.550 --> 01:45:40.630
by talking to people who are not in these walls.

01:45:40.810 --> 01:45:42.229
So thank you so much for having me.