Dr Sara Jahnke III ( The Science Behind Shift Work and Disease) - Episode 928

This episode is sponsored by a company I've literally been using for over 15 years now and that is 511. Now my introduction to their products began when I started wearing 511 uniforms years ago for Anaheim Fire Department. And since then I have acquired a host of their backpacks and luggage which have literally been around the world with me. The backpack where I keep all my recording equipment is a 511 backpack. And then most of my civilian gear, the clothes that I wear are also 511.

Now more recently they've actually branched out into the brick and mortar stores. So for example Gainesville where I do jiu-jitsu has a beautiful 511 store. So if you are a fire department, a law enforcement agency, you now have access to an entire inventory of clothing and equipment in these 511 stores.

Now I've talked about the range of shoes they have and how important minimizing weight in our footwear is when it comes to our back health, knee health, etc. I've talked about their unique uniforms that are fitted for either male or female first responders. And then I want to highlight one new area, their CloudStrike packs. For those of you who enjoy hiking, this would even be an application I believe for the wildland community.

They've created an ultra light pack now with a hydration system built in for rucking, running or other long-distance events. Now as always 511 is offering you, the audience of the Behind the Shield podcast, 15% off every purchase that you make. So if you use the code SHIELD15, that's S-H-I-E-L-D-1-5 at 511tactical.com, you will get that 15% off every single time.

So if you want to hear more about 511 and their origin story, go to episode 338 of Behind the Shield podcast with their CEO Francisco Morales. Welcome to the Behind the Shield podcast. As always, my name is James Gearing.

And this week I have a very important conversation, especially when it comes to trying to move the firefighter work week to a 24-72 shift pattern, which would result in a 42 hour work week, a far cry from the 56 to 80 hour work weeks that a lot of our firefighters are working, especially when they're understaffed. Now in this conversation, so many people have asked me, James, can you show me the research?

And so I reached out to my friend who's arguably one of the most respected researchers when it comes to health in the fire service, and that is Sarah Jenke. Now we've done two podcasts before, episode 245 and 401, where she really kind of breaks down some other areas.

But this time we honed solely on sleep deprivation and shift work so I could kind of build the understanding of how detrimental both chronically and on a daily basis and acutely this is not only in our performance and obviously the lives lost through mistakes, whether it's driving, whether it's pushing the wrong meds and the financial element of the lawsuits that are attached to that, but also the horrendous chronic impact.

And as you will hear everywhere from mental health to cancer, it is a huge common denominator. But one of the most startling things that she brought to this conversation was the impact on our fertility, but also the massive increase we have seen in our profession when it comes to childhood diseases, so pediatric cancers and autism and some of these other areas.

Now to round off this conversation, as you will hear, there is just simply not much money given to the fire service when it comes to researching this ill health. So Sarah talks about the studies are out there. Obviously she talks kind of an apples to oranges comparison with some of the other professions, but she also highlights how little research has been done in those areas. So therefore waiting for quote-unquote research is only going to prolong the suffering within the fire service.

So really understanding the common sense element that a shorter workweek would improve physical and mental health and have a huge cost savings is a beautiful takeaway from this conversation. Now before we get to this interview, as I say every week, please just take a moment, go to whichever app you listen to this on, subscribe to the show, leave feedback and leave a rating. Every single five-star rating truly does elevate this podcast, therefore making it easier for others to find.

And this is a free library of well over 900 episodes now. So all I ask in return is that you help share these incredible men and women stories so I can get them to everyone else on planet Earth who needs to hear them. So with that being said, I welcome back onto the show, Dr. Sara Jenke. Enjoy. Music Well, Sara, I want to say firstly, welcome back. I think this is number three, if I'm not mistaken, of our conversations recorded, you know, and then obviously we've had numerous outside of that.

So welcome back to the Behind the Shield podcast today. Excited to be back. Always enjoy it. Always a good time. So where on planet Earth are we finding you today? I am actually at home today and I'm very excited to be home. I have been on the road the last few weeks and I love doing that and having like outreach, but there's nowhere better than home. Nowhere better than my own bed. There's a lot of guilt as a parent not being around with your children either. So much.

And I try to teach them like, you know, this the work that I'm doing is important. And here's how it's affecting the world and all those types of things. And I'm like really trying to be positive about that. And I try and take them when we can, when I can take them places. But the end of the day, when my daughter's like, but I want you home, I'm like, I want to be home too.

Well, that's actually a beautiful segue to what we're going to talk about today, because I just had a couple of Firewives on recently behind the Women Behind the Dear Chiefs podcast and one of them had talked about when their son was very small. He was all in on the fire service. He had the costume. He had the trucks. He had everything. And they happen to have a conversation with him when he was now, I think, 14, 15.

And they said, you know, you think you're going to become a firefighter like your dad. And he was basically the version of fuck no. He said, and they asked, well, why? And he said, because dad's never home. And this is the thing. There's a difference between the mission, the purpose, the job. That is why I would argue the best profession on the planet. I mean, I'm a little biased and the environment that we work people in. Those are two separate conversations.

So I'm really excited to kind of unpack that with you today. Yeah, it's a complex question. And I do. I think there's it's well, I think I have the best job in the world because I get to work with fire service and sleep in my own bed. But, yeah, it's not there's not an easier, straightforward answer to any of the questions, but that's what makes it interesting. And more research is always needed. So it's job security for me. Absolutely.

Well, you are what we refer to as culturally competent as well. So just give an overview of your kind of family connection to the fire service. Yes. Well, and I also never considered being a firefighter, which it hadn't occurred to me until one of the women from Women Fire said, did you ever think about doing it? I'm like, oh, no, God, no. Sounds awful. And part of it was that, you know, dad had to be gone, especially when as a chief and being.

You know, just never know when he had to go for something and never and kind of like even just the psychology of not being present in the moment a lot of times. So I also would not want to be a fire chief. That also sounds like a horrible job, but they're fun to study. But, yeah, I grew up in the fire service and my dad was the only child.

So all my family, extended family on his side was all fire service folks and got into research because I was going to be a clinician with kids working with kids and then hated working with their parents. So needed a plan B and had done military research in grad school and fire service that just started funding research. So that started like I think my first funded grant was 17 years ago now, which makes me feel old. I entered the fire service 20 years ago, 2004. I don't like numbers like that.

Doesn't that seem like the 80s? Someone said the 80s was almost like early 80s. That's almost like 50, 50 years. I'm like, I don't know. I saw that same post. I think it was a film, something that was released in 85. And they're like, just so you know, this would have been 50 years ago. Oh, my God. No, thank you. Yeah. I guess it was the 70s. Had to be 70s to get the math right. But even so, it was terrible because I was born in 74. So, well, with that, let's start at the beginning.

Then you enter this field. I'm always asked and we're going to get into this exact conversation. Well, James, what about the research on shift work on this on that? What was the landscape of health research in firefighters when you entered 17 years ago? Oh, yeah, almost nothing. So about 80 percent of the research that's been done on firefighter health is the last basically since FEMA started funding research. And that was, I think, when I think about 16, 17 years ago.

No, it must have been a little bit more than that. Eighteen years, maybe now. But FEMA has the fire prevention and safety underneath that. They have a tiny pot of money, like maybe five or five studies a year on firefighter health. And it's not if you look at research now compared to where it was then, like it's exploded and there are so many groups doing good work. And we're learning so much more about cancer, cardiovascular disease, mental health, reproductive health.

And like every question that we answer leads to more leads to more questions, which is awesome. And it's not that every every research team is funded by FEMA, but I have yet to find an article that doesn't reference some of the work that was funded by FEMA. So I think it just really raised the awareness. And then, you know, then you have news stories about cancer and firefighters, which sparks more interest in research and those types of things.

And so, I mean, we used to struggle because like the big funders, like National Institutes of Health, because firefighters such a small population. Initially, like the conversation was it was really nearly impossible to get research funded by NIH. But now they're, you know, they're they fund research on firefighter health sometimes still challenge, but it's still possible. It's now possible, which is awesome. What I've seen and again, this is through my own awakening.

It's not like I was aware of this 20 years ago because I wasn't. But what I realize is there's there's a kind of myopia in research sometimes. And so and I've talked about this many times. If you look at firefighter cancer, it was for the longest time, the carcinogens completely legitimate, same way as COVID-19 is a virus that will mess you up if you are immune compromised, for example. So definitely a factor.

And then when it comes to the mental health, oh, well, it's because, you know, you saw this thing, you were at Grenfell, you were, you know, the Vegas shooting. That's why you're struggling. And then you kind of reverse engineer and you look at all these other factors. And what I've noticed, you know, and I think even until very recently is that when it comes to cancer, there's no talk at all about sleep deprivation and the breakdown of our immunity when it comes to mental health.

It's the same thing. There's no discussion that, hey, by the way, we use sleep deprivation to weed out people in selection for special forces and to interrogate and torture. You know, there's no conversation of the link with mental health and sleep deprivation as well. So I have to admit, I one of my favorite favorite questions to ask a scientist is what were you wrong about? Like, what is something you used to believe that you don't believe any longer?

And I think one of the things that I have to admit to is that I did not think sleep was as important as I now think it is. You know, I used to think of it as like it's important. It's a component of overall health and wellness. The man, the more I started getting it, someone asked me to do a presentation on sleep and I had like some data like we published an excessive daytime sleepiness. And so it's like some broad things, but I hadn't really dug into it.

All right. So I said, OK, I can I can put this presentation together. So I started pulling the literature on it. And by the end of that, by the time I gave that presentation, I started it with basically like this is the biggest risk that you face is the sleep deprivation and interrupted circadian rhythms. And I I don't think I will ever say I'm wrong about that statement. Given the research and the more research we do.

So, yeah, I think that for a number of for a number of evidence based reasons, I think that I just I think it's I think it drives a lot. And it's completely under recognized. Yeah. When how long ago was that study that you had to put on sleep with that presentation? Probably about five years ago. I mean, we asked questions before, like we asked questions about sleep. And so we included it. We looked at it as a covariate. But I just don't think it wasn't until then.

And then Joel Billings from Oklahoma, I've done some work with him. And he is the other thing that really convinced me. I was like, yeah, all right. You're right. I'm wrong. I'll go with what you have to say. Because I want to say that might have been right around the time we did our first interview and I remember that you weren't all in on the sleep thing at that point.

So that's really interesting that you say that now, because obviously there's been an evolution and don't get me wrong, it was only three short years prior to that that I heard Kirk pass parsley on the barbell shrug podcast. And I was like, holy shit, this is this is the missing piece of the jigsaw puzzle. Hundred percent, hundred percent. And now I'm like, how did I not see that earlier? But there are all sorts of things that I wrong on.

That's one of the things that I'm that I'm good at doing is admitting when I'm wrong, because I'm wrong quite often. You and me both. Sorry is used many, many times in my vocabulary. Just my my understanding has evolved from when I originally said that. So, yeah, I bet now I think I want to go back and listen to our first podcast. I'll probably be like, damn it, Sarah. It wasn't it wasn't against it. It was just I don't think that was that, you know, leaping in with both feet element.

Yeah, no, no, definitely not. But now I'm like, I'm all in on this as a topic. So well, let's look at the broads, the view first. Now, you know, we have fire departments in the US that I would argue you have the gold standard and you could even push if you're talking about elite performance, even less than 42. But, you know, 42 puts you in line with the average citizen, the average civilian. So the 24 72 is big in the northeast.

You know, we've got Boca Raton here in South Florida and now Boynton Beach has gone to it and then you've got a majority that are working a 56 hour. They may or may not have a Kelly, you know. And then with this hiring crisis, now you have mandatory overtime, which actually I had since my, you know, Genesis into the fire service. So now you're looking at 80 hours a week on those weeks that they get hit with that. You got the federal firefighters sort of working 72 hours a week.

You've got wildland firefighters deployed for weeks at a time. So the overall view, what is your impression once you start understanding the impact of sleep deprivation on all the things of the culture of the way we are worked in the fire service at the moment? I think it's and it's actually it's partly been listening to your podcast, but I've really been reevaluating some of my own assumptions on because the challenges and some of the big. OK, let me step back.

Some of the early research on sleep and the fire service, because FEMA did fund some research early on around like sleep education and awareness and looking at sleep disorders and the impact of impact of sleep disorders, which, by the way, I got to throw this out there. They are I think it's about more than a third of firefighters have a sleep disorder, often undiagnosed, so like low hanging fruit.

We need to make sure that everyone's getting screened for sleep disorders and treating the sleep disorders they have. So that's a side as a side conversation. But we need to make sure that people are doing that because they think that's like the impact of that related to everything from cardiovascular health and depression, you know, drowsy, driving, all that kind of stuff. So important.

But, you know, I've always the early research kind of a pushback was that everyone was afraid people were trying to do away with 24 hour shifts and and the challenge of moving to if you're not going to do a 24 hour shift, what would you do? At the end of the day, I think that someone has to be awake at 2 a.m. or at wake up at 2 a.m. when whatever happens happens.

You know, grandma falls or there's a fire or, you know, someone stubs their toe and feels the need to wake firefighters up because they have a stub toe. But so, you know, I think the inevitability of someone having to be up at night, we've all just said, well, you know, if you got to be up at night, you know, we're not going to do away with 24 hour shifts.

But now I see like we're doing now we're going, oh, but let's do a 48 hour shift or let's do, you know, can you work your 10 days all in a row and then be offered? So I think that it's really. Now, I think all those assumptions are up for grabs. And especially, you know, especially in the progressive departments, I just hear so many more conversations now than I did before. And even beyond, you know, someone has to be up in the middle of the night.

But can you have does everyone in the department have to work the same shift schedule like maybe that's not the case. And can you get coverage, can you creatively deploy or deploy resources and look at where you need resources, when you need resources, those types of things, L.A. cities doing some changes to theirs.

And it's it does go back to a lot of the recruitment and retention and the new generation that's coming in and new parents that don't want to miss, you know, putting their babies to bed at night. So I think I think people are getting at least the circles I'm in. People are getting super creative about the way they're looking at shifts and what we really have to do. And I think it's just always been sacred. And so we just never. Question it before.

So, yeah, the analogy I've used for many years now is when I've seen the conversations, it's like a Rubik's Cube and people will spin it and go, oh, 48, 96. And it's now all green instead of blue. And it's like no one's ever saying, why is the cube so big? Right. That's the issue. And so and when people say, oh, we're we're moving to 48, 96. I'm just like, you know, facepalming so hard. I mean, you just look at massive step back on the facade that it's going to be better.

And if you look at and we'll get into this in a second, you know, the chronic and acute effects, let's take the acute for a second, you know, the the improved chances of all the things going wrong from an intersection wreck to falling off an aerial or getting lost in a fire, you've just, you know, increased exponentially. Oh, yeah, yeah. And I think at first, because I still have people and I just confirmed your podcast, but I'm like, when I say, you know, what about a 24 72?

Because now anyone that starts bringing up shifts, I say, you know, 24 72 is working in some places and it's always that's just not possible. So I think in the past, everyone's just said, all right, well, instead of even asking a question about the Rubik's Cube, we're just going to like put it to the side, like, well, we're not even going to look at a smaller Rubik's

Cube. So, you know, this is and you were an early adopter on this idea that maybe this is maybe we're maybe we're looking at the wrong Rubik's Cube to start with. Well, I mean, what I've seen is all the way from firefighter through to chiefs and then city and county administrators, we've all believed fairy tales.

Now, the civilians believe that we sit around smoking cigars, petting the Dalmatian and waiting for a fire once a week, even though they they really don't think about the fact that there's nonstop sirens outside their window all day long. And then we go around telling people we have the most amazing shift.

And I only work one day on two days off or I work eight, nine days a month, which is absolute bullshit because a day for most people, if we're using standardized is a nine hour day with a one hour lunch. That's eight hours of work. We work three days crammed together and then have one day off because that second day we work from midnight to eight a.m. So it's one day. So it's three days on one day off or 30 days a month. So this is the thing.

While we believe our own lives, we're going to move the cube to the side. What we need to people to do is say, wait a second, why does everyone else work 40 hours, but you asked me to wake up from a dead sleep, slide down a pole, get in the back of a tiller truck, navigate to the fire without killing someone, make entry, find the child, pull them out, doff my gear. We can now do a pediatric cardiac algorithm on 56 hour workweek or eight hour workweek.

That's what we've got to think about to debunk it because, oh, well, never happens. Like, well, you don't think your family deserves to have you home as much, if not more, as a person that works in the bank or the grocery store, I disagree. Yeah, yeah, I just think it's I and honestly, I think some of the fear of getting rid of a 24 hour shift has driven just a dead stop to the shift conversation at all. And I think that's what's starting to change.

It's like, all right, so if we're going to, you know, let's let's evaluate shifts. Let's start talking about it. Let's and then what are the variations? So I think it's I think it's a good I'm optimistic, although I've been told that I'm what Rhonda Kelly uses the term apoc. I'm an apoc optimist that you like, no matter how much everything's going to shit, you're going to just be positive. It's going to end up end up well.

So I always have to be positive that like this is a we're headed in the right direction. When it makes sense, it gives me the anger and energy to keep pushing forward. It's simple, you know, when you know that eventually there's going to be an aha moment, that's what spurs me on. I call myself an angry optimist.

I'm not all hearts and rainbows all the time, but, you know, it's going to get better whether it means dipping my knuckles in glass and punching my way through or, you know, lifting everyone up with poetry as long as the end game is the same. Well, and I'll just feed the data out so then you can I mean, it'll all work out beautifully. It'll all work out beautifully. But no, I think that it is.

I do think that this is the missing piece, and we're doing what we can to collect data on it so we can say like, here's the you know, here is the impact. Here's the quantifiable impact. Because like you said in some of your other podcasts, like you got to make the case for it. So if you can make the case to city, county, you know, that you're going to have these improved outcomes. And it is, you know, it is a return of investment question.

You know, it is an upfront cost that is significant compared. But in the long run, you know, you're playing the long game with this, but any elected officials playing the short game, you're playing till the end of their elected term. So, yeah, exactly. Well, I think that's that's the point. I mean, you and I and I'm sure a lot of people listening, if we were burying our friends, that would be enough to force change. But sadly, that's not the case in many, many places.

So the money side is the big thing now. Again, that doesn't seem to be data and I'll definitely kind of get you to expand if there is. But what I've seen is where you can identify an obvious, you know, bleeding of finances on the back end is all anything related to health. You know, you work with comp claims, you're over time covering vacancies, you know, all the things, your medical retirements and then the lawsuits from mistakes that we make because we're so tired. So the money is there.

But let's let's unpack the impact of sleep deprivation shift work on the individual's health, mental health, physical health. And then at the end, we can kind of revisit the immense savings that cities and counties would find if they if they fix that problem. So where to begin? Yeah, exactly. Let you look at my list like, OK, let's jump in on the acute impact of sleep deprivation on cognition first.

So now we're addressing accidents and line of duty deaths, I would argue, from the, you know, the getting lost in the fire type incidents. So so what have you kind of learned about the impact of sleep deprivation? And I know a lot of studies would be that, oh, well, one night, Matthew Walker, one night without sleep is a blood alcohol. Yeah. Well, let's talk about 10 years of that, because we're not when these aren't college students volunteering for a 12 day

study. Right. Well, and I do love Matthew Walker and I do love all of his work on his why we sleep like game changer. And I think game changer because I used to say it scared me into sleeping better, but I think it really gave me permission to prioritize sleep like before I felt lazy if I was getting eight hours, eight hours to sleep at night. And now I'm like, I'm optimizing my health. Like I'm doing this to be just a better person, to be healthier, to be happier.

So so I do think that immediate, even if you look at well back to the work by Laura Barger and the and Sizer's group at the challenges with for firefighters with sleep disorders, like the numbers there, I think I have them in a I have some of my numbers in the background because I usually just give you the not throw out numbers. But I'm like, I don't know if that's actually the number or if I just made that up. So I did make sure I had this.

So she looked at this firefighters with sleep disorders versus not 37. I was right. More than a third. Thirty seven percent screen positive for sleep disorder. Twice as likely to motor vehicle crash. So if you think about like even the risk of driving to work drowsy or driving home from work drowsy, because I also want to talk about changing shift start times, because that's what another piece that I think is important.

But more than twice as likely that the odds ratio two point four one to report falling asleep while driving. Like that's incredibly dangerous, dangerous, especially if you're driving a fire truck. Imagine that on a second day of a 48 hour shift. But also it was related to cardiovascular disease, double the risk of cardiovascular disease, similar for diabetes.

And then the piece you talk about cognition and the relationship with things like mental health, depression, three times the risk of depression and anxiety. It was almost four times the risk. So like those are huge.

And if you think of that just being the interrupted, you know, the interrupted sleep due to the sleep disorders, I mean, I think that's a close approximation, but that's among firefighters who are already struggling with sleep disruption and interruptive circadian rhythm, which, by the way, World Health Organization classified shift work as a probable carcinogen, like just that. In and of itself has the scientific evidence that that it could be classified as a probable carcinogen.

Like that's huge. That's huge. Absolutely. Well, with that, then, as far as cognition, like I forget who it was now, one of the the guests I had on was talking about microsleeps and how they done a study, I think it was on law enforcement, you know, and the number of times that they basically blasted through a red light. Now, hopefully they made it the other side. But, you know, the tabloids are full of intersection wrecks. So talk to me about that. Microsleeps.

Oh, and it's about like long blink that you feel like I like I'm just long blinking. No, you're not. Your body is actually paralyzed for like two seconds. And it is your body trying to capture what it needs in that two seconds of sleep that it's getting. So you're like you basically your body is basically paralyzed. Right. So there was a study and this is not me advocating for drunk driving.

But when you look at drunk driving compared to sleepy driving or drowsy driving, like it doesn't seem like that big, but you're like, oh, you're just a little bit tired on the road. No, drunk drivers see what's coming. And they sort of to not hit it. But when they studied accidents, they actually found that drowsy driving was even worse because you're hitting stuff head on.

Like you do that long blink, which we call it a long blink, but it's actually sleeping, paralyzing your body for two seconds. And then by the time you open your eyes, it's too late to swerve. So in a lot of ways, if you look at like how dangerous or deadly they are, drowsy driving is more like don't drink and drive. Don't be a drunk driver, but also don't be like it's that serious.

And it's you wouldn't you wouldn't be like, well, it's OK if people are going home drunk from the fire station, but we are basically putting them and sending them out of the firehouse. Cognitively intoxicated driving home sometimes. And that's one of the things is the particularly early shift change times and then driving home drowsy.

And most people are driving, you know, most of the departments I've been talking to about their shifts and particularly with the start times, like about half their department lives between 30 minutes and an hour away from the station. Some places it's way more than that. But that's it. That's not a small. That's not a small amount of time or a small issue. No, mine was 75 minutes most of my career each way. Crazy. And what and what time did you change shifts? So well, here's the thing.

So you have when you're supposed to change shifts, which that's when the turds will show up, you know, but the good firefighters will usually get there 30 minutes or so prior to make sure that their brother or sister has just been in the meat grinder for 24 hours or more, doesn't catch another late call. So you're looking at, you know, like I was getting there around seven just after seven. And so, I mean, I was getting up about five in the morning. Yeah, yep.

We did a study, one of the studies we did with Joel. We were looking at 24 48 versus 48 96. And the thought was, oh, we're looking at the differences in the. And these were not very busy departments, but we thought we were looking at the differences in the two like schedule structures, but the big like, oh, my God, take home was how short slept.

People are coming to work and leaving work like five point six and five point eight hours and under six hours, I mean, even under seven hours, but under six hours is where you see everything going to shit from reproductive health to inflammation, to mental like, you know, that after if you're sleeping that little, you're it's 100 percent affecting your health. Testosterone production, all of it, all of it.

And most firefighters in that study, on average, were coming to sleep, coming to work short slept and leaving short slept often because of a seven AM shift change time. That's one of the studies that we're proposing is to look at departments that are changing that to later and see, do people, you know, do they just stay up later or can you actually get people to get more sleep and have better health outcomes? See, and I like that conversation as long as it's not the only conversation.

People like, oh, we're going to revolutionize our fire department. We're going to come in at seven PM. OK, well, have you had the conversation about the whole 56 hour thing? No, no, no, we're just going to. OK, well, again, prioritize. But if you imagine you did a 24 72 and you decided for zero cost to come in, I mean, I would say like midday that way, most people get to have breakfast with their kids before they go to school and their and their spouse.

And then, you know, the rush hour traffic has died down by that point. And then you you know, you get in and the on the crew didn't have to be woken up at seven AM by dispatch, which I don't understand that to this day lights come on so they can if they've had a rough night that I'm sleep till nine or 10, they know that rigs checked out. They were just in it, you know. So, yeah, I mean, that side makes a lot of sense to me as well.

Yeah, no, I think I mean, imagine if you could do both and that would that would I mean, I think changing a shift start time is I think the benefit of doing that for a department that's not willing to talk 24 72 is it teaches them that like this is not a sacred cow that can't be touched. Like we can we have control over this. We can do this. And then I think you can move them into the the 24 72 because if you have that, you know, here's here's how things improved and we can improve it even more.

I just think it's I just think it's been everyone, including myself, has been hesitant to. Say. To even talk about shit, you know, it was 10 years ago, 15 years ago, the conversation just shut down. Mm hmm. I know. Yeah, I mean, we're just not going to we're not going to talk about that. Yeah, we're just layering on to the the acute side before we go to the chronic disease side. Matthew Walker states in a blood alcohol point one, basically, which is over the legal limit.

But that arguably is probably a bunch of college students that were asked to, you know, to not sleep for 24 hours once, you know, and then go back to probably sleeping in their own bed every night. In our profession, you've got these people doing it every third day for 10, 20, 30 years. Have you seen any kind of studies or is there an understanding how far from that point one our first responders probably are? You know, I mean, the cognition is, like you said, terrifying at that point.

But if you amplify it by times X, then, you know, I can imagine we're even further into the hole than most people think we are. Yeah. You know, it's a good question. I've never I've not seen that quantified. I'm going to make a note, though, and I'm going to look it up and confirm that I'm right about that. But it's a great study to be done. You know, I think that I think it's a great study to be done because you could look at it in a couple of different ways. You know, people who are.

Well, we don't have to design a study right now, but there are a lot of different ways that you can look at it to quantify that. Yeah, I think it's just important because it's cumulative. And we know that in the sleep medicine world, that sleep debt is a real thing. So if, you know, like you said, your actual shift, even if you don't get woken up, you know, we're having that kind of half one eye open, half sleep. So it's not a deep restorative sleep.

I would argue the same as probably the night before, because I was always anxious to get up and not missing my alarm. And then that middle day, which is on us, ownership part, if we've been drinking that night, then we've disrupted our sleep that night, too. So, you know, you've just got this slow decline over time. Which is another one. I think that it's under recognized how much alcohol impacts sleep. And we know, you know, alcohol use in the fire service relatively high.

And you think like, oh, I'm going to have a drink to relax and go to sleep or to drink excess drink to excess and pass out. We are actually interrupting all those rhythms. And you will be waking up overnight without remembering it. So you think, oh, I slept all night. And it was actually didn't you. You woke up all night long, but you don't remember it because of the alcohol. Not interesting. It is. Well, I mean, it's funny because the sleep medicine world's metric is how tired are you?

That's the thing that they study. So, you know, a number of times you think about you drank. You always feel terrible the next day. And actually, Kurt Parsley said that what alcohol does is show your fatigue beneath, you know, beneath, basically. So when you're tired with alcohol, it's because you're tired. You're actually tired. So I was talking to one guy who a firefighter from.

I think I was talking to him in Arizona, but I don't think that's where he was from, and he did like a self study, so he did. I can't remember if he used loop or an or a ring, but he like altered his alcohol. This is the kind of I think this is the kind of research we can get firefighters really involved in purposely drinking at different times and different amounts to see what happens.

And he said even with one drink, he had poor sleep, like objectively measured poor sleep at night from from one drink. And if you think about on average when firefighters drinking or drinking three point five of whatever it is, servings of alcohol, that's you know, that's a significant impact as well, I think. Yeah. I mean, if you think about it, it's a toxin and your body's needing energy and blood flow to remove that toxin because you just poisoned yourself.

And don't get me wrong, this is Cambodia, by the way, not beer that I'm drinking. But as we're having this conversation, there is alcohol in it, though, a little bit. But, you know, but it is it's self sabotage, which is the T-shirt I made this recently, self care and sabotage. It's exactly what it is. But yeah, so when you think about it with the kind of common sense lens, of course, your sleep's disrupted because the body wants to not be digesting something.

You shove down your cake hole at 10 p.m. and not be metabolizing the sugars and alcohol. It just wants to rest and repair. So, you know, it does make perfect sense. Let me take a step back. It's kind of irrefutable that if you poison yourself, yes, your body's going to have to focus on that. Well, when you say it that way, it seems very obvious.

But I also think, you know, what we see with the alcohol use, and this goes back to the big, you know, your your big picture comment about it's also interrelated, like we know that alcohol use is often used as a coping mechanism, you know, it's how you manage all the other stressors. And I also think so I and I don't have data to back this up. So I could be lying and I could write this as a hypothesis. I guess is what we should call it. Not that I'm lying.

I think that another another sleep piece and tying it to the mental health is if you look at the way sleep is structured and how you remember and how you forget, I think that part of what might be driving some of these mental health issues, particularly symptoms of post-traumatic stress with like the intrusion, the intrusive thoughts, those types of things.

I think it could be because of that interrupted sleep, because you're you know, instead of taking things from short term memory to long term memory and weeding out the neural connections of a wait, no, you can pack this away. You don't you don't need this piece. I think that's getting. I think that's getting screwed up. It certainly is. I know the sleep medicine world has shown that for all different areas of mental health.

But that's when you process memories, that's when you discard things that were useless, everyone that you passed in your car that you don't need to remember. But it's also when you process some of those traumas. And then if you think about you're not sleeping well any of those three days, then you're slowly kind of, you know, your brain is getting more and more full and more overwhelmed. And I think physiologically, the brain literally takes a bath at night.

And that's kind of when a lot of this happens. So you're regenerating neurons, you're processing the drills that you did the day before so that you can actually be better at that skill the next day. Sleep is imperative for that. And we're taking it away and it's not able to do a lot of those things. So there's there's no question. I mean, your hypothesis is right because the sleep medicine world has shown it.

Well, if you think about so what we're seeing, like with post traumatic stress disorder, we're doing a study on that right now, which, by the way, if you know anyone who's struggling with post traumatic stress and nightmares, we're trying an abbreviated intervention for it. So it's a four day basically workshop on how to retrain your brain on these things.

And that's when we look at we've been doing a lot of assessments of people's symptoms and when you look at like a standard PTSD, it's a flashback to a very specific incident, you know, and the definition of PTSD was basically derived out of military experience and often unemployment. But they tend to be like very discreet experiences. And when we ask when we talk to firefighters about their experience and that repeated exposure to trauma, it's not necessarily one or two things.

It's like flashbacks to multiple things. That's thousand cuts. Yeah. When it's one firefighter was saying, you know, I was in a really interesting conversation between two guys in one of my classes, one I'd known for a long time who struggled with some post traumatic stress and another one who was new on the job. And he's like, I don't get it. Like, it just doesn't bother me. I know people talk about all this, you know, and he was like a year on.

So and the other guy goes, you know, it scares me to hear you say that because you think it's never going to bother you. He goes. And then one day you're sitting at breakfast and you take a bite of cereal, look up and see that, you know, look at your daughter and you see the face of a girl that died 10 years ago that you dug out of a ditch.

And it's like how much of that memory popping back in or that visual popping back in is because that memory, that call was not properly processed that night during sleep. Yeah. You know, and I know we can't get that specific with the science, but if you look at what we what is working with treatments for things like post traumatic stress, it's basically retraining the neural connections in your brain, you know, reprocessing things and appropriately putting things where they need to be.

And I'm just wondering how much of that is because it didn't get packaged away where it was supposed to. After the call, yeah, what an equal and opposite, you've got the slow breakdown over those 10 years since that call, so if you had that call and then, you know, being in a healthy shift system where you slept well and you got to process it, you probably never would have had that flashback in the first place.

The 10 years of not sleeping and the cycle that we just described, your resilience, your ability to enough for your brain to try and process that or not, you know, let the barrel explode in your mind. You know, your your equal and opposite ability to do that is being destroyed slowly. Right. Yeah. That's why I think it's all related. And it's all why I why I think realize now that I was wrong. Well, again, I mean, like I said, it's such an awakening.

It's interesting because I've interviewed Dr. Russell Foster, and he is the guy who actually discovered the chrono receptors in the eye and was laughed at by the world of ophthalmology at that point, there's Rodster's Cones that's that. And he proved it. And then they were like, oh, shit. So he's actually even though I don't really hear him credited for this by a lot of people that are very big on social media now talking about this, he's the person who actually discovered it.

And so I had him on the show and we talked about this. And this is this sleep is everything. It's absolutely everything. And he put it as basely as, look, you're supposed to be asleep when it's dark and you're supposed to be awake when it's light. And so we're asking these people to do the opposite of this swing shifts or 24 hours at a time. Yeah, we're defying our biology for everything.

And so in return, the least we could do as a society is make sure that we give them type of environment where they can recover from that, minimize it as much as you as much as you can and minimize the impact. But. Yeah, well, let's go to hormone disruption because I feel that's a good beginning of the umbrella that we can start unpacking a lot of the other things. So now we're kind of getting more kind of long term. And it doesn't mean I say long term and doesn't have to be years and years.

It's been talking days and months by this point. But what are you seeing as far as hormonal disruption by sleep deprivation? Oh, so reproductive health is the research on that is blowing my mind and is. Ah, man, again, underestimated, did not see this coming. Like we we knew right in the 90s, there was some research on or a couple of review papers that were put out on reproductive health and women in the fire service. And they basically like laid out, here's the research that needs to happen.

But then none of it happened. And so now what we're seeing on things like everything from fertility for men and women in the fire service, but also miscarriage for women, double the risk for career firefighters in the general population and even higher than that, 42 percent higher for volunteers. So we know, you know, in all those reproductive health pieces are run by your hormones and that the circadian rhythm of your hormones, all those types of things.

So one of the things and we've all again looked at like, oh, what are the carcinogen exposures? But if you think about it, if cars, the research on volunteer that are that because we found the same result for preterm labor to where that's where I was like, wait a minute, if if it's all carcinogen exposure and volunteers typically get less exposure than career firefighters on average, what else do they have?

Like, what are the other things that are driving the impact of what might be affecting their reproductive health? Maybe being on call every night. You know, maybe that is maybe that's the bigger the bigger impact. The other thing that's interesting is you see similar fertility, some fertility and preterm. I think it was just miscarriage. I don't know that we asked preterm labor with law enforcement. And again, like, what's the common? Yeah, they're on the fire ground, but.

It can't just be fire ground exposure. They're only there to park their car in the way of the fire, and then they walk away from it. They're not really exposed. Right. Exactly. Exactly. And their cars don't get cancer.

But but would we see those same, you know, what are what kind of what's the common thread that is that the chronic inflammation and the stress and the interrupted circadian rhythm, like what because we, you know, there there there has to be some common threads and it can't just be fire ground exposure. And that's what I think we've always assumed fire ground exposure. But I don't I think that a lot of that reproductive health stuff is driven by not just exposures on the fire ground.

We're looking at working with Jeff Bridges, he's looking at anti-malurian hormone AMH. It's hard to I always screw that up when I say it, but I think I got it right that time and found that it basically being in the fire service ages your reproductive health system faster for women than if you were not. So looked at new recruits versus women who'd been on for a long time. And then new recruits before recruit school or at the beginning before they were fire exposed and after.

And now we did before and after fire exposure because the assumption being that the fire exposure would be a big impact and it probably had a piece of it. But I don't that there's no way that that's all it is. There's no way. And the fertility, like if you look at sperm, like the amount and the virility of sperm, even with like, what was it? A week, a week of short sleeping decreased. Sperm motility and virility. That's right.

I don't I have been talking more about sperm than I had in the past, but I you know, the sperm is not as good basically after like one week. So I don't think it's really a shock that firefighters are forty six male firefighters, forty six percent more likely to get fertility treatments than the general population. Well, I've seen it.

I mean, you know, observational research now, the number of firefighter friends, male and female, that have experienced multiple miscarriages, that have used fertility treatment, that have had the children with spina bifida and Down syndrome or pediatric cancer. I mean, it's everywhere. And I don't know. Maybe if I became a carpenter or my carpenter's friends would be going through that, but I don't think so. I think this is far more rampant in our profession.

I think I think you'd know people, I mean, because I think some of this stuff is environmental and people are not sleeping as much as they should anyway, but in the general population. But I think it would. I think you would know forty six percent more. You'd see forty six. You'd see forty six percent less than if you were a carpenter. Well, you jumped up for a second when I was listing some of the things. Health outcomes. I don't know.

Have you been reading any of the stuff on child health outcomes or some of the conversation going on about it? No, I have not. And I need to. So this is not going to be good news for you for anyone. I from a scientific perspective, I'm very excited about this. Is what can we figure out next from a firefighter and child and their and their family's perspective? This is this is really going to be bad news. So I apologize for seeming very excited about it because that seems like an asshole

thing to do. But this is an opportunity to learn from it and fix things. That's the excitement. Oh, my gosh. So there was there was one study out of Kitsap, Washington. It was an EFO report and it found a really high rate of pediatric cancers among offspring of firefighters in a specific department like the I should reach out to the guy and talk to him because I cite him all the time. But it was an extremely high rate.

And he did his EFO report and research childhood cancers because so many kids in his department, so many of the kids of his firefighters have had had had had cancer. So he basically standardized the rates. But it wasn't like the rate was extremely high. So I think it wasn't generalizable to the population as a whole. But when we looked at one, it's definitely something that needs more research. We just published with Miriam Culkins at NIOSH.

We worked on a study looking at birth defects in the offspring of male firefighters. So it's this huge database. And there were not that many male firefighters. I can't remember how many we ended up having all together, but they owned several, I think, four or five birth defects that in that population, even though there were not that many firefighters, were increased among the offspring of firefighters. So the question really is like, it can't just be that like we need to look bigger.

We need to look broader. We need to figure out what's, you know, what's going on there. We've put a couple of studies together, we're a couple under review and then a couple we've had discussions about. It's a hard question to answer, right, because you have to ask, you got to access the firefighters, you got to ask, get valid information about the kids, those types of things. So we're trying to figure out the best way to do it.

But when I was on like a planning meeting with a bunch of firefighters, or a bunch of scientists, and we started saying, like, all right, here's the challenges, you know, it's the exposures, it's the because we do know that there's epigenetic changes in sperm, it looks like. But there's the exposures. There's the circadian rhythm disruption. There's the we're laying out all these things.

And they're like, oh, yeah, we would definitely expect to see higher issues with it in the offspring of firefighters. And I'm like, why? Like it was just like assumed. Oh, yeah, I mean, we can help you quantify it. But but it was everything from like autism spectrum disorders to attention deficit. So more research needs to be done. But I think that's another area when we look at impact. And the other piece of that is that we have no data on but has been raised. What about like that generational?

Like if you have three generations of firefighters and is there, you know, are you basically like collecting everybody's negative health impacts? You know, I I don't I don't know. Again, more research is needed. But yeah, that's it's that's an area that you'll see more on it. We're doing what we can to to design the studies now. But it's funny because when we put in a first proposal for that, like five years ago, we didn't even get past fire service relevance at FEMA.

They're like, well, this really isn't a firefighter health issue. That's a firefighter off offspring health issue. But now we're like, well, I don't think anyone would argue that now. Like it easily gets through fire service relevance.

It now comes down to like the science. But if you look at things like reproductive health, miscarriage, fertility issues, child health outcomes and you look at those, everyone's talking about cancer, but if you look at those as more proximal health outcomes of the total occupational exposure. That gives you things, you know, cancer, we have to wait 30 years for that develop to develop. But we know that risk factors that we're looking at now and you can see that.

Basically faster, because it's the same risk factors. It's the interrupted sleep. It's the exposures. It's the stress that the chronic inflammation type stuff. So I think it's we can't we can't go, oh, that's not it's not cancer. So it's not important because it is all it's all those risk factors. It's just looking at them, you know, earlier. Basically, well, I mean, you ask a firefighter, would you rather your child have cancer or you the child is going to be more important.

So it is absolutely fire, fire relevant. Well, and that the other thing that I think we can use it as is like I hear all the time like, oh, you know, but you don't die from cancer, from cancer till you're old, you're going to die of something. Hopefully, if I have cancer, I just, you know, don't catch it till late and I die quickly, like, first of all, you never think that once you're dying. I have never met a firefighter who's like, man, I'm so glad I waited for my cancer to be diagnosed.

Yeah, exactly. I was right. You die sometime anyway. I'm fine. I'm fine. But you say, oh, all right, then don't you know, you don't need to worry about this now because you are going to die someday, but you might need to worry about it because having a child with a disability takes a lot of time, money and energy and is very stressful. So like, don't do that.

So I think for some people who we can't hook them on the like at 70, you might have cancer, you can it well, except that we are seeing firefighters get develop cancer younger than the general population, too. But but I think that some of those folks, you can hook them on. If this is not just about cancer, this is this is about your kids health. It's about your, you know, their kids, like it's just it's a bigger picture than that, it's about can you get your wife pregnant or can you get pregnant?

So absolutely. Well, one metric that we do have that will be a beautiful indicator of a lot of these being a potential is the hormonal blood work. One of the real moments I had, again, as I become this perpetual student from all these people that I interview now was the immense breakdown of testosterone from sleep deprivation.

And the old school thinking was, you know, our men and women go in and say they happen to actually get those done, the male would say, oh, well, the doctor will say, oh, you're fine, you got three hundred. Well, you know, from one fifty to nine fifty, whatever it was that when that was done in the one of the Ivy League schools, the nine fifty was the 18 year old quarterback brimming with everything that teenagers brim with.

And then the one fifty was the 80 year old dude, you know, sedentary dude that was about to croak any second. And so, you know, so it was woefully under recognized, but then there was a full pendulum swing where men's clinics opened up everywhere. And this is where I think it's even worse. So now you've got 30 year old firefighters whose testosterone is in the toilet, which seems to be an epidemic. And again, it's a complete correlation between the two.

But rather than being told about their nutrition, their strength, their conditioning, their sleep quality when they can control it, they're just being prescribed TRT, which is now breaking down their innate ability to make testosterone. And now they're a drug addict for life. So what have you seen as far as, you know, a very quantifiable element, which is testosterone levels in both male and females in the fire service?

So I don't think that we have at least I know IFF was working on a white paper on that. I don't think that we have a great published data on that. Although I've started talking to some of the health groups because some departments want to measure that. The other piece with testosterone, too, is that Denise Smith just published on the importance of testosterone and its role in cardiovascular disease and increasing cardiovascular risk factors.

So I think that's another another piece beyond just, you know, beyond the that to add to the conversation, I guess. So I don't think that we have great data. Mostly health providers I know who who do have they're saying exactly what you're saying. It's like either everyone in the departments on testosterone or no one is and no one's and no one's talking about it. So it's one one end or the other.

I don't know that we have great data on it, partly because it's not typically added to the health exams. I don't I don't think. Actually, I'm going to have to think about that. I don't think that it's in standard exams. Some departments, I know, test it, but I don't know that I've seen anything published on it, I think is my is my answer on that. But I do know it. I mean, I'm not at all surprised that it's an issue.

And I'm also not at all surprised that the that the range is that I mean, it's kind of like with thyroid functioning thyroid function test, right, like we used to say, OK, the range is relatively wide. And as long as you are within that range. But if I not small part of the general population actually does have thyroid dysfunction, then you're including scores that are in that are actually causing

symptoms in that range as well. So well, and also understanding the free testosterone and same with the thyroid, the free thyroid versus the the ones that people normally measure, because you could look and go, oh, you're fine. But it doesn't mean that that is available for the body to actually use. So as we progress and move on, I think these these companies like Transcend, who I use, are amazing. They do such a thorough blood work and then they have middle of the road solution.

Now, the ultimate solution is to get back to homeostasis naturally and then live in the Garden of Eden. But if you are going to be working shift work, then you've got some of these supplementations like DHEA and peptides that you can do that just bolster your body rather than being hooked on CRT. And there's no way back from that. Yeah, I and I think that you're right on with the you can't just. I don't. I think.

I was going to say something not kind about dock in the box, and if you have a if you have a billboard, that probably means. If you need a billboard billboard, but I'm not going to say that because I don't have evidence to support that. Maybe they're all doing great jobs. But yeah, I think you're right. You have to be really thoughtful about that. You have to make sure that you're testing. I mean, there is that specific algorithm of how you test when you test those types

of things. And so I think it's often that's not taken into consideration. But absolutely. Well, I mean, low testosterone, for example, can contribute to not only, like you say, to cardiovascular ill health, but also weight gain. And then it's imperative for mental good health as well. So now you've got another layer to this is your day functioning. I mean, that's the that's the thing is it's yeah, it's also interrelated. But the apoco optimist in me says it's also interrelated.

So if you start improving one, you're going to be improving the others. Exactly. So it's high return on investment personally. And I do think you brought up the like the things that you can do and that's you know, yeah, someone's going to have to be up in the middle of the night.

But I think it does make it even more important that people prioritize their sleep, understand what they can do and do what they can when they can, you know, and over an all nighter every once in a while is not just a no big deal. Like that is actually incredibly bad for your sleep, particularly if every other day of the month or 20 days a month, you're going to have really crappy sleep anyway. Oh, there was also sorry, I just love it. Other studies and I'm like, oh, yeah.

And there was a study that I recently read. It was a review and it's actually a newer measure, a newer assessment of sleep. Because, you know, before it was primarily measuring like total sleep time or sleep opportunity is one of the major outcomes. So I just read an article. I can't remember what it was, what they what the term they called or like what they called the measure, but the outcome of it was looking at consistency of sleep and they found that unrelated to.

Unrelated to the or in addition to independent of independent of is the word I'm looking for. I don't think I my flight was late last night, so I did not sleep great. But independent of your total sleep time, the consistency of your sleep is also a key driver. And how can they use they had they developed an assessment of it. So basically how consistent is it is that you will be asleep at the same time at night and the next day. But I think they even so this.

And I think if I'm remembering this correctly, they looked at added in like if you're consistently napping. So basically, as long as you your score is based on if you are asleep at the same time, how consistent you are. And it's a score from zero to 100 on how likely it is you're going to be asleep at the same time every day. And that independent of total sleep time was. And sleep opportunity was predictive of mortality and several other outcomes. Interesting, right?

Well, let's talk about the weight gain, because I think this is a big part. You know, again, you've got the diabetes. I mean, they show how there's a complete insulin disruption with one night of not sleeping. But then you've obviously got this hormonal disruption. So talk to me about the the impact on sleep deprivation for the ability for the body to maintain a good body composition. Horrible one. I mean, I think that sums it up quite nicely in a scientific term.

But for several different reasons, like one, because it controls when you feel hungry and when you don't feel hungry. So you actually are hungrier if you have this interrupted circadian rhythm. There was a guy out of Dr. Panda from the Salk Institute. He did a study in San Diego where they did circadian feeding.

And his hypothesis was that the interrupted circadian rhythms from shift work are not only because of the sleep wake cycle, but that part of what controls the circadian rhythm is when you when you eat. So you basically are telling your body if you're if you get back to the station and eat a brownie, you're telling your body like, oh, it's time to wake up. You know, we're doing wake up things and we're. And so if you can also limit your feeding windows to the times that you are, you're.

You should be awake that that can also be helpful. He did some really interesting studies in mice early on, but it looks like that is also a part of it. So it's everything from like how hungry you are. And obviously you're going to eat more if you're hungry to just the way your body uses the calories that it had. Like, it's just all it all goes back to sleep. It all goes back to sleep. This is why I feel so stupid for not seeing it earlier.

What made you because you were really early adopter on this topic. It was Kirk Parsley hands down. I was listening to my 75 minute commute. I listen to podcasts all the time to Joe Rogan, Tim Ferriss and then barbell shrug the old crew and they had him on. They were talking obviously about the impact of sleep on performance in the gym. They weren't shift workers.

But when he started kind of telling about how he had these uber athlete seals because he was a seal pre 9 11 went to med school, came back as their physician, the West Coast Seal team, and for a year he just kept seeing the blood work come back and he's like, they're like eight year old women. What's going on? There's no complete disconnect between who they are, what they can do and then what

the shows. And so after about a year, he realized that nearly all of them were on Ambien, which again, you don't get sleep with a sleep pill, you're just unconscious. So and so he was able to persuade his command in his profession, people actually listen to active health advice and they were able to shift because they were doing a lot of night training and kind of reframe it in a way where they got a lot more sleep.

And then he actually developed a formula I used to this day on occasion where it was just vitamin D and tryptophan and magnesium and tiny bit of melatonin to initiate the sleep cascade and got all these guys off Ambien. So while I'm listening to this and he's talking about the acute effects of sleep deprivation, the chronic effects of sleep deprivation, and I've always said firefighters don't die of one thing, they die of everything, whatever the weakest link is.

And so it just made so much sense to me. It's not just carcinogens in a fire that are causing cancer, and it's not just the trauma that we're seeing that are causing suicides. There's everything from childhood trauma through to the massive impact of sleep deprivation. So it was a real penny drop for me, a penny drop, not a panty drop for anyone that misheard that. But I guess, I mean, educationally, maybe. But yeah, and then it just everything aligned. You drop.

But yeah, and everything is I had a background ex-fizz, you know, and athlete and a coach. So I had some of the pieces as well, but that was that was just it. That was the missing piece. And so I had this massive aha moment. Your training and background, like, did you talk about sleep back when you went through school and back when you.

No, no. And this is the I mean, I remember, for example, in London, because I did kind of like the A.S. in London and then my E.A. and U.F. like literally just a few years ago, I haven't picked up my diploma yet, but I've got it, my bachelor's. But I remember I'm talking about them processing learn skills when you sleep, and I thought that was interesting. And then fast forward, you know, it explains why the next morning, I can't remember the not that I was trying to tie the day before.

There's actually an issue behind that. So, yeah, so it wasn't that we had really learned about it before. It's just that, you know, because in sports science, it's very, very myopic. And that was disappointing. You study a very few slithers of things, but it doesn't make you a good coach, in my opinion. So, yeah, it was more just the kind of lived experience and then combining what I did know about physiology and some of these other areas and then sleep just like you.

One day someone slides it onto the table in front of you and like, how the hell did I not factor this in? It makes perfect sense. Every animal goes to sleep and we are animals, no matter what anyone says. Yep. Yeah. A good thing we're seeing it now, right? Absolutely. So then back to the obesity then.

So just kind of talk to me about some of the impacts on the human body that from sleep deprivation that, you know, over time will, you know, will lead to obesity unless someone's very diligent with their diet and exercise. So I do I think appetite is one of the major drivers that you just. You're more hungry the more you eat, the less you're able to manage your calories. So I think that's a big a big piece of it. And then I think that what were some of the other things?

I so oh, so one, the being hungry, wanting to eat more and also not having enough sleep makes you more likely or less likely to. Engage in physical activity, so I think it's both of like all in addition to all the hormone dysregulation, I also think that it's the even just the health behaviors. And I also think probably more likely to drink alcohol as a coping mechanism if you're not doing like it's all tied together.

Right. So if you're not using that, we use physical activity to maintain, manage my stress levels when you use alcohol. So I think it's that too. I mean, I think it's I think it's all interrelated. Yeah. Well, I mean, those low hormones, testosterone is what gives you that kind of motivation to go get under a barbell. You know, so I mean, there's an actual measured hormonal response to sleep deprivation that takes that away from you. And a lot of people feel exhausted from it. Yeah, yeah.

And if like if you're if you're tired all the time, you are all the health behaviors become more challenging to do. So I think it all plays in together. Absolutely. Well, you can touch on this before the World Health Organization has sleep deprivation as or shift work as a probable carcinogen. And again, they're probably studying people that don't work 56, 80 hour weeks with 24 hour shifts.

So with that being said, though, talk to me about what you've learned as far as the correlation between sleep deprivation and cancer. So so the shift works, the comment about the shift, most of the shift work is based on like nurses and physicians, right? Which, yes, they have to be up at night, but they don't tend to be up at the same with the same regularity, you know, as as

firefighters do. So I think that's why it's important to have specific research to research very specific to firefighters because it's it's. It's just not the same and even law enforcement, you know, where we see actually on several cancers, there was a study that was just done out of Ontario and cancer rates for. Law enforcement offers officers for several cancers were similar to cancer rates for firefighters. And again, what could that be?

You know, it's not that they're fighting fires or going interior and managing those exposures. So I think it could be some of that shift work piece of it, too. But their shifts are very. They're very different. And that's the thing, you know, when people say, oh, because I have had people say like, oh, everyone should just go to eight hour shifts, but someone has to be up at night, so someone's going to have the impact. And you do want as much consistency as possible.

So it'd be even worse to go between like day shifts and night shifts. So so I think that with the relationship to cancer, so they classified it. I want to I want to say it's a probable person, and I think it to be and I think it's probably due to the impact on just the impact on the immune system. Right.

There was one study or I think a summary or maybe this is from your I'm not sure where I pulled this, but I have a note on it that specifically linked to breast cancer, prostate cancer, cancers of the uterus and colon cancer. But if you look at like those what breast cancer, prostate cancer, I mean, those are the endocrine disrupting chemical cancers. That's the reproductive health cancers. It's all, you know, also has to do with the hormones.

So I think it has it's likely and Jeff Burgess says that he thinks a lot of what's driving that really that relationship is inflammation. So likely the inflammation is really pushing that. And it's really just taking it, impacting the inflammation in your body, which then encourages cancer cells to grow. I did have a note to routinely sleeping, sleeping less than seven hours a night doubles the risk of cancer. Yeah, the mechanism there is assumed to be the immune system.

Like your immune system just can't fight off what it would if you were sleeping. Well, this is it. This is the conversation even though I was having right at the beginning of COVID is, you know, we were asking our first responders to be and our doctors and nurses to hold the front line, and yet they were arguably some of the most immunocompromised, you know, people of any profession. Now, outside of obviously, you know, morbid obesity and all that kind of stuff.

So talk to me about that, the impact, see deprivation on the immune system specifically. It just I mean, it you just cannot operate. Your body is not designed to operate without sleep. I think my favorite, like level setting on this actually did come from Walker's book where he talks about that of all the stupid things that are done with the Guinness Book of World Records. They don't allow people to go the longest without sleep.

Because it's so dangerous, like there's that guy who created a sonic boom with his body, and that's in the Guinness Book of World Records, some 39,000 feet in the air or whatever, but going without sleep is that dangerous. But, you know, that's it's not I I saw a firefighter in L.A.

L.A. County who happened to be on he was at the second busiest house in the country and I saw him 72 hours after he'd got I was there when he got on shift and I saw him 72 hours later when I was doing a data collection like it didn't even look like the same person. And you just and I guarantee you that was not the only time he'd worked a 72 hour shift. Your body just is not made for that.

Speaking of research, though, I've got a friend, Miguel, who was a recon Marine, but also got into their human performance side and he was asking me about research. And I'm sure I'd said that, you know, about you being one of the people I know that really is doing this kind of overall health research. And he said, you know, what would the study have to look like?

And I was like, well, you'd have to basically get a group of people to be awake for some or all of 24 hours for, you know, a month and obviously have another group that's not. And he goes, you know, what's crazy? He said that would never get past an ethics committee in a study. So when people say to me, James, can you show me the research? I'm like, no, because no one in their fucking right mind would actually put normal people through what they were put through.

Right now, there's yeah, no. We and I think what we are trying to start doing it, we're just trying to start to. Why can I not talk to well, because they didn't get enough sleep last night. You're a subject for this conversation. Right. Sarah seems like an idiot because she got in late on her flight.

But what I do think we can start doing is really specifically studying busy departments and the busiest stations at the busiest departments, because one of the challenges with what we've done and did in the past. I should not have scheduled this podcast when I would be sleep deprived. I didn't realize I would be this sleep deprived.

But when we did like our we did a study called Field of Fight, it's 20 departments, Maine to Guam, and we did study and survey on excessive daytime sleepiness, like it was obviously linked to working 48 hours or more linking shifts, independent or private sleeping quarters was sleep promoting and decreased excessive daytime sleepiness. But what we did where we screwed up is we just classified the departments by the shift schedule that they worked. Right.

And some of these departments had we had, like I said, LA County was in it. One of them was the second busiest truck or second busiest house in the country, I think, and then another one like we went in, we sat down, we had coffee, we kicked, but they didn't have one call the entire time we were there. And so we've done that where we've classified based on the department is a 24, 48 or the department's, you know, and not classified on. But how many calls did this person run?

So when we average out or averaging, well, it doesn't look that bad. That's because you have people who sleep all night at an airport station and people who are so so these people are great. These people are horrible, but it looks on average like they're OK. So that's what that's and that's where research is going is. All right. If we're going to study this, we have to study the busiest fire departments and the busiest stations in the fire departments to really get there. But yeah, you're right.

You could not randomize people to the condition that you could not randomize people to that condition of just don't sleep. Yeah. No. Well, with that, one of the pushbacks I get is like, oh, well, there's, you know, we've got the station out in the woods and they only run once a week. You tell me that they need to do a 24 72. And I'm like, yeah. How many times have you been into an apartment building, seen a security guard sitting there reading a book or whatever?

Do you shout at him and say, why are you not in a fist fight with a bad guy right now? No, he's he or she are there for when you need them. And arguably, usually out in the past, just stations, you know, these are all firefighters that kind of paid their dues in the meat grinder and transitioned out to somewhere a little slower, but they're already screwed. Yeah, exactly. Yeah. They're just waiting for cancer.

Just like they said. But, you know, so so to not advocate for all the people who are just getting murdered every day in stations because of the off chance that you might make it a little easier for someone who's got it easy is complete insanity. And it would be like, you know, the full time transatlantic pilot is held to aviation sleep standards and then the UPS guy that works part time flying. They go, oh, yeah, we can't fix full time

because Steve, the part timer, it will be easy. It doesn't make it makes no sense. Another industry. But this is what I get over and over again. And it's like, well, if you've got more time off, then you just have an opportunity to rest, but also to train because those quiet stations need to be ready as well. Right. Well, and you still have both of those people in the same department, right? Working the same shifts. And so. You have to plan for the person who is getting their ass handed to them.

The most like and then you figure out, you know, the rest goes where the rest goes. But you can't plan on the quietest, least busy like you would never do that. It's like you said, the transatlantic guy, you don't ever go like, we're going to only require him to do what Steve does. No, you're going to require Steve to like same same story. You've got to you have to plan for a worst case scenario. Like that's what the entire fire service is about. Right.

Or when it comes to our people, but we know whatever. Exactly. Exactly. As I said, we're we're amazing at burying our women, which is really shit at stopping them dying in the first place. Yeah. Yeah. Yeah. Well, we're going to fix that. All right. Well, speaking of that, though, good segue. There has been. I mean, we're talking nationally. I've done this for almost eight years now. And it's the same kind of perceived figures observationally.

But the figures that I've seen is that we die on average within five years after retirement and about 12 years younger than the population. Now, again, you know, there's there's going to be a spectrum of places where it's better or worse, but over and over and over again, that that number five after retirement law enforcement as well seems to be a very observational thing. Like there are men and women, they are watching them die, you know, a few short years after they retire a lot of time.

So what have you seen from a scientific point of view as far as the longevity of these men and women that give 25, 30 years of their lives and then finally get to close to or retirement age? So here's what I want. And I would love if you have any access to that data, because I've heard that before and I've had a hard time validating that that five number. So that's why I would if you have any data or if anyone who's listening has that data, I would love to see it. There was early on.

Someone told me that there was like a dissertation that quoted it. But I'm trying to track data down on that. So that's what I would like to know. Yeah. Well, that's the issue. Like I said, we don't have research. A lot of times, observation is all we do have. But then again, we're also looking at should I had a comment on that? Oh, I also we're looking on average at that. So if you think overall, you would expect firefighters to live longer.

If all other things were created equally, you would expect them to live longer because you're looking at averages and. You would expect that because they're actively working like the healthy worker effects that they should be living longer, so it but if you have data on that, I would love to see it because that's that's one that I've always tried to track down and have not had much luck.

Yeah. And I bet you it's probably because they there's a resistance to that information because then we'll realize that we are killing our firefighters because I've always said it shouldn't even be equal to the average person in our community. I would argue that your firefighters are some of the fittest, most resilient men and women when they enter that career. And so really, we should be living longer than a lot of the community. Not not sure. Yeah, I have not done a search on that in a while.

So now I'm going to go do that and I'll let you know. Brilliant. All right. Well, then let's transition now to, as I mentioned, you know, if if really investing in your people and their well-being isn't something that motivates you to advocate for change, then sadly, we're back to money. So what are your observations on the false economy of the way our firefighters are being worked and then the potential comes?

Obviously isn't an area that you've studied specifically, but you know, if you take that money from downstream and invest it upstream and create an extra shift, so now you have a four platoon system and a 72 hour period to recover, what what would you hypothesize as far as the financial benefit to a city or a county? So I I think that we will see. I mean, you you have like the obvious, you know, not having to pay as much overtime, those types of things.

And I think that's low hanging fruit. But I also I think that you would see there was one department out of that just went to a longer shift and they were reporting increased rates of mistakes on EMS calls. So I think you're right on that.

I think that, you know, if we shorten that, if we I think, you know, honestly, I think with improved sleep, you should see pretty much everything improve, you know, everything from like your lost work days, from people getting colds and flus, you know, like just immune system pieces, everything from that to the injuries to the and it would depend on injuries like they're that's where we're going to really need to look at the the stations, the busy stations, the busy departments.

But I think you should really see everything improve. I think you should see overall health and wellness improve. I think you should see, you know, we know that obesity is related to more lost work days. And I think it was like an average like fifteen hundred dollars more per firefighter per year that is obese for related to injuries, I think is what it was calculated at. So you should see those.

You should see less, you know, less obesity and more and less injuries because so much of so much of the injuries are driven. So many of the injuries are driven by things like like musculoskeletal strains, sprains, those types of things. So I think you I think and I don't know, you know, and I get it. We need the empirical evidence to back this up. So we're trying to design the studies in a way that we can can capture these pieces.

But I think you would overall see everything like fewer workers, compensation claims, less likelihood of people going out on disability, those types of things. I mean, I think it will improve overall mental health injury like I my hypothesis is all of it would get better. But we'll have to see. It's an empirical question. Yeah. I ask it. I think, again, going back to what makes sense, I mean, obviously it makes sense with the injuries was interesting.

You asked me about sleep when I was doing sport science. The other thing that I did learn is that when you sleep is after breaking down the muscles through training, it's when you're rebuilding and so your muscles, your tendons, your ligaments, that's when they rebuild after the stresses of the day. So if you're taking away that rebuilding time through sleep, they always say, oh, it's always the fit guys that get hurt. It is because we take our training seriously.

And not only are we pulling hose and doing drills out in the yard, then we're lifting weights or doing CrossFit or ultra marathons or whatever the person's thing is. And so there is it's not if it's when you will get a breakdown. But again, if you give more rest and recovery, your at your firefighters have become become greater athletes because then they're going to be more resilient. They're not going to get hurt as much.

I mean, again, from the strength and conditioning gurus have had on here, they validated that completely, even with the sporting athletes they work with. So I will say because I've heard that, oh, if you don't work out, you're not going to get working out. And I'm like, well, yeah. But if you look at injuries, so, yeah, if you work out, you're more likely to get a some type of like overall rate of injuries higher. But they tend to be minor sprains, strains, those types of things.

If you work out particularly, we asked specifically working out on duty, you are half as likely as your colleagues that don't do that to get a fire ground injury, so that catastrophic fire ground break or whatever. So I think that at the end of the day, like, yeah, you might have a strain or sprain. And I think a lot of the programs that really get like knocked for, oh, you're always you're going to get hurt, you're going to get hurt. It's because they're programs that people love to do.

And so they do them more like, yes, the more that you work out, the more often you work out, the more the more likely it is you're going to get injured because that's what you're doing. But the more time I spend watching TV, the more likely I'm going to get injured spending, you know, I'm going to get injured watching TV because that's what I'm spending my time doing.

So I think the overall like I would much rather have someone get that strain or sprain that can be rehabbed properly and that they are able to fix that faster than a major fire ground injury. Yeah, I agree completely. People would say, you know, you work out on shift and say, aren't you afraid you're going to be tired? I'm like, no, I'm probably going to be fit at the most people in the fire ground, even though I'm tired. And that's the difference. Right. Right.

All right. Well, then let's let me see here. What else? So, yeah, and that's the last thing I want to hit then, really, because we've obviously painted the picture of how this is an impact that can either continue to be negative in the fire service or create some incredible improvements, everything from health to mental health, financial savings. But here we are now at an amazing opportunity to actually start doing some research.

Now you've got departments like Boca, sorry, Boynton Beach and then Gainesville in a few months that are literally about to. So if you could capture them right before. And I think I think UF or somewhere around there might be. You know, we've got an option then.

So to, you know, to create studies to kind of further, I mean, really capture this horrible system, hopefully, as we start going away from it, what needs to happen, who are the governing bodies and what should be the studies so we can capture this information because we didn't before. All we've got is today.

So what we what what has been working well, and I've actually talked to the people in Florida, is we're creating a what are the standard measures that we should all be using so then we can compare because it's the number of variations is like insane, the number of variations, even of shift schedules that you can do. So we're looking at how can we standardize data collection on that?

One of the things that we have in that we have a proposal in on, but we also are putting it in and moving forward with an IRB just because we need the data as it evolves is to do all right, let's study these things pre and post with surveys, let's study pre and post where we are in everything from mental and physical health to injury and then look three months out. How does it improve sleep? Does it improve all these other health parameters? And look at what data we have available.

So a couple of departments I've talked to have can access for like fifteen eighty two medical data and their blood work data, those types of things, but even like at the most basic, let's get the survey data out. Let's get people to answer the questions about where things where things fall. So then we can start looking at some of the relationships. So we're going to standardize data collection processes and protocols.

The study that we have that's currently under review is studying a couple of departments, they're getting ready to change their shift to start time, but developing that protocol so anyone can use it and then they could just put it in once you have the data in and cleaned, you just basically can run, you know, with the same the magic statisticians can run the analysis for the different departments. So let's you know, let's look at it, let's quantify it.

And then I think the faster we're able to quantify it, the further people are going to be able to move forward. Yeah, I think I mean, there's a need for capturing it. But at the same time, I love that phrase, you know, don't wait for science to prove what you already know. And so I know some departments are just going to wait and see how this department does and you're talking about years. But meanwhile, you're still burying your your firefighters.

So, you know, I think the the research is important, but also not waiting for some incredible white paper to validate the fact that, you know, you can stop killing your firefighters and like mechanistically, I can't imagine one a scenario where it's going to get worse, you know, like there's not one. There are some things that I understand, like, all right, we probably do want to wait for that, you know, does this actually increase carcinogen exposure or decrease it, those types of things.

But for this, like, I can't imagine a negative like you're not going to start to people become more well rested. And so then you're going to get more injuries like that doesn't mechanistically make sense. So I don't think that's I think that more departments, the faster we can get departments to change the better. But I think you're always you know, it's that normal curve, right?

You're going to have your early adopters and then you're going to have the people who need who need some more of the data. So then we'll get that and then we'll get then and then we'll light it on fire. Yeah, well, speaking of early adopters, one of the beautiful things that I've heard, some of the people that had the courage and this is what we need now, only say there's no downside.

The downside is you got to look in the mirror and say it's time for me to advocate for myself, my family and my people if I'm in a leadership position, because that's all that's left, you know, and if you don't have courage, then step down and let someone else come into it. You know, but and then also with such a fragmented profession that it's also, you know, communication.

And I've been very vocal about how disappointed I am that our union that beats their chest has never fucking talked about standardizing the workweek. Shame on you. So it's up to us from the firefighter through to the commissioners to all have a courage to say, debunk our own fairy tales, our own myths and then say enough is enough, you know, we're going to force this change. But with the early adopters, a big selling point is we have a recruitment crisis at the moment. Oh, my God.

I think that's, you know, personally, my opinion is that a big part is that young people are very smart with access to all the information and they're looking at the fire service going, this doesn't look great, you know, and it's the profession is, but the environment isn't. So by going to a 24 72, these departments are seeing people lining up around their door again, just like the good old days. Yep. Oh, 100 percent recruitment and retention.

I mean, I think that that we have to make it just has to appear more. I mean, every meeting I'm in that comes up as a key issue that departments across the country are facing. And so I think anything and everything we can do to make this look like a more attractive, be a more attractive job, allow more. I mean, I know that like conceptually older generations are like a work life balance. We never had that. Well, just because we didn't doesn't mean they shouldn't.

And maybe it's time we start learning from them. Like, you know, sometimes I'm like, oh, work life balance. I don't. And I'm like, wait a minute, maybe I should be taking the time off. You know, maybe I don't have to wake up every morning and get an hour's worth of work in before the kids get up. Maybe I could drink coffee and kick my feet up. So I think that there's some really cool things coming with the next generation.

And I do think they have more of an understanding of things like the importance of sleep, because I think a lot of the people, honestly, who are not pushing for this yet, don't understand how important sleep is. You know, it seems like that's just I mean, sleep is a luxury. You can sleep when you die. Well, you will die sooner if you don't get enough sleep.

So, yeah, well, I always tell the ones that are resistant to not only the sleep conversation, but also the mental health conversation about addressing some things that you've just buried down and filled alcohol over is performance. You know, there's a lot of guys that, you know, wear their leather helmets and grow out their moustaches, but they talk about it's for them being in their chest. And so, OK, well, let's break that down for a second.

If you're worried about performance, then you need to address the things that are crazy in your mind. So you can actually have a relaxed mind to get into a flow state and maybe visualize that bedroom you're searching and finding that child under the bed. But the same thing applies to sleep deprivation. Find your favorite athlete.

I guarantee you they've got psychologists and all kinds of people working on their sleep at a guy on the show, Nick Littlehales, who literally travels with teams and they have their own bedding role for the athlete that they put on the floor. So they optimize their sleep. But you're telling me you're advocating for a shittier work week that will make you far worse cognitively, and yet it's for them. And if it's really for them, doesn't that include your family?

So why are you pushing against the very thing that will get you home more? So even all those conversations, you know, it's this rah rah bullshit that I'm so fucking sick of rather than truly booing. OK, it's for them. Well, then let's actually look what that looks like. What are the high performing groups around the world do for them?

Self care is a huge part, because if you're not in the highest level of physical and mental performance, you might fail and you might push that wrong drug or miss the tube or miss a child in the search or shit the bed while you're holding your, you know, your extrication tools. So even from that point of view, the naysayers, OK, so you're literally voting to be a shittier firefighter. That's what you're saying. I yeah, that sounds good. That sounds makes sense to me.

Yeah, that was a rant. I'm sorry. No, I mean, I can't I can't disagree with you, but I think things are changing. Like I'm going to be. Optimistic, I think we're going to I think I think it's changing, like I think this is culture change, and I think it's, you know, having you beat this drum and getting the. You know, getting data in the hands of people, all that kind of stuff that I think will. Move the needle like I think we I think we. I think that we are at a point in chain of change.

Yeah, I agree. And this is why these conversations need to happen, because there are a lot of conversations about how great the job is and it is, you know, I lived it. But these are the uncomfortable conversations that we have to have about literally reframing the way we think about this stuff. But if we want to, you know, improve our health and performance and stop going to so many funerals with bagpipes and last bells, then this is the conversation. This is the courage that a firefighter has.

This is where it needs to be applied is to finally advocate and push change and get this work week fixed. And then we can start hitting some of the other areas. Yeah, I agree. Any closing thoughts, any other areas you want to kind of throw in there before we close this up? I think we covered all of the topics. I would just say that, like, I think my closing is that like this is change happening. You know, it's not happening as fast as you or I would want, but it's happening pretty fast.

Like if you look traditionally at the whole, you know, the tradition of the fire service and and things were slow to change, like. I think we're going at a pretty good clip comparatively. Like, is it as fast as business? No, but. I'm going to I will remain optimistic that we are on the precipice of change. I said the revolution has begun on my post because I believe that I really do. So the paradigm shift. You're having a podcast about this. I've been invited to speak on this multiple times.

And now there are several Joel and Joel Billings was funded by FEMA to basically redo the sleep. Like the summary and sleep that Kerry Kuehl's group did decades, probably two decades ago, he's updating that now and bringing together sleep scientists to discuss like what we need to be talking about, like, oh, that would not have happened 10 years ago. Brilliant. Well, I'm so excited. So thank you so much.

I mean, obviously, we just kind of really focused on this one particular topic this time, but hopefully now people, you know, when they have that, I need the research will understand where there is research and then where there's not. And obviously, the if you really want research, I've got Rachel Mulquall from the Navy, Kirk Parsley from Navy Seals, Alison Breger from the Army, you know, I've got sleep people, you know, from very comparable positions if you absolutely need them.

Yeah, they figured it out. We will, too. Absolutely. But I want to thank you so much because this was needed. You know, this this hopefully now will kind of appease some of those those needs for research and understand that, you know, in areas we just don't have it. And then, you know, in other areas, take a step back and go, well, this is actually common sense. So and then in other areas still, you've got the papers that you talked about.

And even the research that we don't have yet, like we have a close enough approximation that we can make pretty, pretty certain statements on. So, well, thank you so much. I mean, it's been such an important conversation and an absolutely invaluable part of this kind of group of conversations to hopefully make the case where people will understand the importance of this work week conversation and advocate for change in their own department.

Well, and thanks for continuing to push this issue, because I know it gets frustrating. Occasionally I have like these what the fuck are we doing moments like nothing's changing. But then I look around and I'm like, no, this is this is progress. It's slow, but it's progress. It wouldn't be happening without you doing stuff like this.