WEBVTT - Urgent Rest 0:00:06.640 --> 0:00:12.399 No matter what time of day or night, the er 0:00:12.560 --> 0:00:16.000 is always awake, providing much needed support to patients with 0:00:16.160 --> 0:00:20.040 any and every kind of ailment or injury. Doctor George 0:00:20.120 --> 0:00:23.320 Russo works in a New York hospital emergency room. The 0:00:23.360 --> 0:00:26.520 margin for error in this line of work is razor thin, 0:00:26.920 --> 0:00:30.280 and since the er never closes, finding time to sleep 0:00:30.560 --> 0:00:33.600 and sleep properly is a daunting challenge for George and 0:00:33.640 --> 0:00:34.279 his colleagues. 0:00:35.760 --> 0:00:39.960 There's no plans, appointments. It's whatever comes in comes in. 0:00:40.080 --> 0:00:42.440 Sometimes you're lucky enough to get a notification over the 0:00:42.479 --> 0:00:45.360 phone from the EMS, but that doesn't happen every time, 0:00:45.400 --> 0:00:47.480 so you always got to be ready to jump to it. 0:00:47.479 --> 0:00:50.519 It's a fast paced environment, so you could be seeing 0:00:51.520 --> 0:00:55.240 somebody that's having a heart attack or that is extremely 0:00:55.280 --> 0:00:57.960 sick with something, and then you get a trauma notification 0:00:58.080 --> 0:01:00.920 and something's coming in, and now the doors never closed. 0:01:02.120 --> 0:01:05.440 I wondered, with all of the chaos and urgency of 0:01:05.480 --> 0:01:08.520 the er, how someone like George is thinking about sleep 0:01:08.840 --> 0:01:11.360 and how it impacts his performance. So I asked him 0:01:11.360 --> 0:01:13.760 to recall one of his more hectic shifts and what 0:01:13.959 --> 0:01:16.880 role sleep played in its success or obstacles. 0:01:18.000 --> 0:01:21.760 All right, so it was a Monday. It was Mayhem 0:01:21.840 --> 0:01:24.440 walked into a lot of sign outs from the night 0:01:24.480 --> 0:01:27.280 prior because it was a busy Sunday night already had 0:01:27.280 --> 0:01:29.600 to handle those, but we also had new patients coming 0:01:29.600 --> 0:01:34.160 in for seven am sharp, and then patients were coming 0:01:34.240 --> 0:01:36.440 in from the clinics as well, because sometimes they have 0:01:36.560 --> 0:01:39.000 extremely high blood pressure, they get dizzy and faint when 0:01:39.000 --> 0:01:41.480 they're getting blood taken, and I'm dealing with all of 0:01:41.520 --> 0:01:45.360 those people. And then a stroke alert comes in with EMS, 0:01:45.400 --> 0:01:48.160 so you have to do all the protocol for that 0:01:48.320 --> 0:01:50.160 because time is brain, as they say. 0:01:50.840 --> 0:01:51.760 And then we had. 0:01:51.640 --> 0:01:54.600 A stab wound to the chest come in shortly after, 0:01:54.760 --> 0:01:58.200 so there is a lot of things happening. And then 0:01:58.240 --> 0:02:02.200 there was also COVID patient's coming in, so they're taking 0:02:02.280 --> 0:02:05.120 up the isolation rooms so you don't have exam rooms 0:02:05.160 --> 0:02:07.960 for the other patients, and there was there was just 0:02:08.200 --> 0:02:10.560 a tremendous amount of things going on, and we had 0:02:10.560 --> 0:02:14.360 to transfer patients for some emergencies that our hospital didn't 0:02:14.360 --> 0:02:17.440 have the specialists, so you're on the phones as well, 0:02:18.480 --> 0:02:23.639 and it was it was a day, and I think 0:02:23.680 --> 0:02:26.360 I was lucky enough that I had had like a 0:02:26.360 --> 0:02:28.720 good eight hour to sleep the night prior, like I 0:02:28.760 --> 0:02:32.200 went to bed, I don't know, probably ten pm. And 0:02:32.240 --> 0:02:34.120 since I was there at seven, I woke up at 0:02:34.120 --> 0:02:36.919 six and I felt pretty refreshed. And it wasn't one 0:02:36.919 --> 0:02:39.560 of those nights where I had to split up my 0:02:39.720 --> 0:02:42.760 sleep or I wasn't switching back and forth from days 0:02:42.760 --> 0:02:46.440 to nights. And I think it really helped me get 0:02:46.440 --> 0:02:48.160 through the day. And let me tell you that night, 0:02:48.280 --> 0:02:51.600 I certainly slept well again because I was in bed 0:02:51.680 --> 0:02:54.200 I think at nine point thirty and I didn't wake 0:02:54.240 --> 0:02:55.600 up till the next day at six. 0:02:55.720 --> 0:02:56.320 It was great. 0:02:59.320 --> 0:03:02.519 What role does our sleep play in our long term health? 0:03:03.000 --> 0:03:06.440 How deep does healthy sleep go into our biology? And 0:03:06.520 --> 0:03:09.680 how do you get consistent rest and healthy sleep when 0:03:09.720 --> 0:03:13.560 your bedtime is constantly in flux? Find out on this 0:03:13.639 --> 0:03:24.600 episode of Chasing Sleep Urgent Rest. Hi, I'm Anahad O'Connor, 0:03:24.800 --> 0:03:29.320 and this is Chasing Sleep and iHeartRadio production and partnership 0:03:29.320 --> 0:03:37.440 with Mattress Firm. 0:03:37.520 --> 0:03:41.840 So there's definitely a stress that comes with the high 0:03:41.880 --> 0:03:44.680 stress environment that's very difficult to wind down or to 0:03:45.000 --> 0:03:47.800 just leave at work. Everyone says, don't take it home, 0:03:47.840 --> 0:03:52.000 but sometimes it's not possible. I mean, when things are 0:03:52.080 --> 0:03:54.400 life and death, and when maybe there's a bad outcome 0:03:54.400 --> 0:03:56.280 of something, it's gonna stay with you. 0:03:56.320 --> 0:03:57.680 It just doesn't go away. 0:03:58.040 --> 0:04:01.200 With the intensity. There must be some payoff when things 0:04:01.200 --> 0:04:03.640 are life and death. The downside is that when something 0:04:03.640 --> 0:04:07.320 goes wrong it can be very grim, but when things 0:04:07.360 --> 0:04:09.640 go right, it must feel pretty rewarding. 0:04:10.240 --> 0:04:14.160 The most rewarding part of what I do is when 0:04:14.880 --> 0:04:19.680 family members or a patient feel better in front of you, 0:04:19.720 --> 0:04:22.920 whether it's you give them antibiotics or you give them 0:04:22.920 --> 0:04:26.479 something that helps bust a clot that is causing a 0:04:26.480 --> 0:04:28.680 stroke in their brain, and you can see them go 0:04:28.839 --> 0:04:31.360 from not being able to move one side of their 0:04:31.400 --> 0:04:34.400 body to them being able to move it within hours 0:04:34.800 --> 0:04:36.880 of them being in front of you, and family members 0:04:36.920 --> 0:04:39.599 are crying so happy, the patient's able to talk to 0:04:39.640 --> 0:04:43.000 you afterwards. That's happened a couple times, and it's extremely 0:04:43.080 --> 0:04:47.680 rewarding when you can actually change somebody's life in a 0:04:47.720 --> 0:04:49.080 matter of minutes to hours. 0:04:49.600 --> 0:04:54.200 From bustling cities to sparsely populated rural areas. Emergency medical 0:04:54.240 --> 0:04:57.560 care is a NonStop job. Hospital staff are on their 0:04:57.560 --> 0:05:01.400 feet hour after hour without respite because accidents and injuries 0:05:01.440 --> 0:05:02.520 don't follow a schedule. 0:05:03.120 --> 0:05:05.960 Yeah, the physical aspect of the job, especially after a 0:05:05.960 --> 0:05:09.160 twelve hour shift, wear and tear is absolutely there. I 0:05:09.240 --> 0:05:12.599 mean there's muscle aches that felt like I was back 0:05:12.600 --> 0:05:16.840 playing sports. It's very difficult to find time to work 0:05:16.880 --> 0:05:19.640 out after a twelve hour shift, especially if you have 0:05:19.640 --> 0:05:22.080 a commute, and sometimes these twelve hour shifts go to 0:05:22.120 --> 0:05:25.039 thirteen fourteen hours if something terrible comes in rank before 0:05:25.080 --> 0:05:28.919 the end of it, and it was just it was exhausting. 0:05:28.960 --> 0:05:31.080 I mean, it was very difficult to get in a 0:05:31.120 --> 0:05:34.400 good rhythm of things as things were changing so often 0:05:34.560 --> 0:05:38.839 throughout the pandemic, and also just to get a good 0:05:39.120 --> 0:05:41.800 routine at home, to get to bed at a normal hour, 0:05:41.960 --> 0:05:44.480 to also find a way to eat in there and 0:05:44.520 --> 0:05:47.440 watch a show with your loved one, or if you 0:05:47.440 --> 0:05:49.760 have kids, to find time to be with them because 0:05:49.760 --> 0:05:53.719 they were home all day too. It's hard, it's grueling, 0:05:53.920 --> 0:05:57.039 it's fast paced, it's long days, long nights, and the 0:05:57.080 --> 0:06:01.560 schedule is constantly changing. All of that does a number 0:06:01.640 --> 0:06:05.840 on our mental functions. It's difficult enough working when you're exhausted. 0:06:06.320 --> 0:06:08.880 It becomes even more challenging when the stakes are as 0:06:08.960 --> 0:06:14.039 high as they are in emergency medicine. I wanted to 0:06:14.080 --> 0:06:16.800 learn more about what's happening inside our bodies when our 0:06:16.800 --> 0:06:20.400 sleep schedules change, and what the impact is on medical professionals. 0:06:20.839 --> 0:06:23.600 So I called up doctor Sema Cosla. 0:06:23.800 --> 0:06:25.120 I'm doctor Sema Cosla. 0:06:25.160 --> 0:06:28.080 I'm a sleep medicine physician and the medical director of 0:06:28.120 --> 0:06:30.200 the North Dakota Center for Sleep and Fargo. 0:06:31.760 --> 0:06:35.040 So you have a really extensive background in sleep, and 0:06:35.560 --> 0:06:37.760 first off, I think sleep is really challenging for a 0:06:37.800 --> 0:06:40.320 lot of people. So I wanted to get your thoughts 0:06:40.360 --> 0:06:44.440 on what do you think actually constitutes healthy sleep. 0:06:45.040 --> 0:06:48.159 So there's you know, when we think about healthy sleep, 0:06:48.800 --> 0:06:54.919 we have to consider quality, quantity, and timing, and so 0:06:54.960 --> 0:06:57.960 we want to make sure that we're getting enough good 0:06:58.040 --> 0:07:00.200 quality sleep at the right time time. 0:07:01.240 --> 0:07:05.080 Seema emphasizes the importance of consistent schedules for shift workers, 0:07:05.360 --> 0:07:08.039 and she's even gone as far as to petition hospitals 0:07:08.320 --> 0:07:13.480 to provide consistent shift schedules for their employees. There are 0:07:13.480 --> 0:07:15.560 so many people who have no choice but to have 0:07:15.600 --> 0:07:20.160 these unusual sleep schedules, you know, like our study subject today, George, 0:07:20.280 --> 0:07:22.920 who's an er doctor, and he and others like him 0:07:23.240 --> 0:07:26.520 have no choice but to work the night shift at times? 0:07:26.760 --> 0:07:29.640 How common is this And do you see a lot 0:07:29.640 --> 0:07:32.440 of patients who have to work these unusual sleep schedules 0:07:32.560 --> 0:07:34.520 and what are some of the common complaints that you 0:07:34.560 --> 0:07:35.520 get from these patients? 0:07:36.000 --> 0:07:37.200 Yeah, so you're right. 0:07:37.240 --> 0:07:40.480 In the medical field, also manufacturing, you know, we see 0:07:40.520 --> 0:07:43.840 a lot of overnight workers. I think the challenge about 0:07:43.840 --> 0:07:47.000 an er shift is that it's not consistent. You know, 0:07:47.080 --> 0:07:49.720 sometimes they'll be kind enough to give you, you know, 0:07:49.760 --> 0:07:52.080 a week of days and then a week of nights, 0:07:52.240 --> 0:07:56.920 but oftentimes it isn't like that, so you're constantly switching. 0:07:57.440 --> 0:08:00.800 And so a consistent shift, even if it is night shift, 0:08:01.040 --> 0:08:04.280 is better than a variable shift, right, because at least 0:08:04.320 --> 0:08:08.320 you can give your body some semblance of a circadian rhythm, right. 0:08:08.600 --> 0:08:09.600 I was wondering about that. 0:08:09.760 --> 0:08:12.960 Yeah, yeah, And so I've written letters before just asking 0:08:13.040 --> 0:08:15.480 can you please, like, pick a shift. We don't care 0:08:15.520 --> 0:08:18.600 what the shift is, just make it consistent, please. 0:08:19.360 --> 0:08:22.760 But picking a shift is easier said than done, especially 0:08:22.760 --> 0:08:25.000 in a field to where your day changes wildly with 0:08:25.120 --> 0:08:27.800 no control over what might walk through the hospital doors. 0:08:28.520 --> 0:08:32.760 So the schedule of an er doctor is not the 0:08:32.880 --> 0:08:35.679 average schedule. It is not a Monday through Friday, it 0:08:35.720 --> 0:08:38.440 is not a nine to five, So the average r 0:08:38.520 --> 0:08:43.440 doctor does about twelve to fifteen shifts a month, and 0:08:43.480 --> 0:08:46.040 they can be anywhere from eight to twelve hour shifts. 0:08:46.400 --> 0:08:49.400 Some in rural places do twenty four hour shifts and 0:08:49.440 --> 0:08:53.040 even thirty hour shifts, depending on the amount of patients 0:08:53.600 --> 0:08:54.800 that the hospital sees. 0:08:55.640 --> 0:08:57.400 And these shifts can. 0:08:57.240 --> 0:09:00.200 Be the morning the swing shift, or they can be 0:09:00.240 --> 0:09:03.840 the overnight shift, night to day shift. It's one becomes 0:09:03.840 --> 0:09:06.360 more difficult to get to bed in a normal hour 0:09:07.240 --> 0:09:09.280 because if you go to bed at the same hour 0:09:09.320 --> 0:09:10.800 that you did when you had to wake up at 0:09:10.800 --> 0:09:13.040 seven am, you'll wake up around seven and then you 0:09:13.040 --> 0:09:16.880 don't work again until seven pm. So I would find 0:09:16.880 --> 0:09:19.400 myself trying to push myself and stay up a little later, 0:09:19.480 --> 0:09:21.520 maybe till midnight two in the morning, as if it 0:09:21.559 --> 0:09:22.360 was a Saturday night. 0:09:23.040 --> 0:09:26.520 Frequently changing schedules, while necessary in fields like this one, 0:09:26.840 --> 0:09:31.040 makes for challenging sleep. So the switch back and forth 0:09:31.080 --> 0:09:35.840 from day to night is never easy with sleep and sleep. 0:09:36.280 --> 0:09:39.400 Especially in the emergency medicine world. We tend to be 0:09:39.480 --> 0:09:42.920 the most sleep deprived or have the most issues with 0:09:43.000 --> 0:09:45.440 sleep because of the shift work and jumping around in 0:09:45.480 --> 0:09:49.320 the schedule with twelve hour shifts. Found that it was 0:09:49.440 --> 0:09:54.959 difficult sometimes to keep a nice sleep routine because my 0:09:55.040 --> 0:09:57.800 significant other, she would get home later and I would 0:09:57.840 --> 0:09:59.319 want to stay up to see her, But then that 0:09:59.360 --> 0:10:02.560 would affect my work or my sleep pattern because I 0:10:02.559 --> 0:10:04.079 would be up till midnight and then have to wake 0:10:04.120 --> 0:10:06.400 up again the next day at six am. I found 0:10:06.440 --> 0:10:09.760 out pretty quickly that that wasn't sustainable. And then switching 0:10:09.800 --> 0:10:10.800 over to nights. 0:10:11.240 --> 0:10:14.400 We all have our different ways of trying to normalize it, 0:10:14.440 --> 0:10:17.040 but you're always going to feel kind of awful when 0:10:17.040 --> 0:10:19.199 you're switched over to nights or when you switch back today. 0:10:19.240 --> 0:10:20.800 It's because it's just like jet lag. 0:10:20.840 --> 0:10:22.319 It's like we flew, but you didn't even get the 0:10:22.400 --> 0:10:23.800 nice francifaication out of it. 0:10:25.240 --> 0:10:28.880 Nurses and doctors are so vulnerable to life threatening mistakes 0:10:29.080 --> 0:10:32.480 when their sleep is jeopardized. A tired doctor in an 0:10:32.760 --> 0:10:36.079 er or an operating room becomes a danger to a patient. 0:10:36.600 --> 0:10:39.920 My sister in law is a doctor in London, and 0:10:39.960 --> 0:10:42.560 I was quizzing her about, you know, how she gets 0:10:42.600 --> 0:10:44.959 through this, working these night shifts and going back to 0:10:44.960 --> 0:10:48.199 a regular shift, and she mentioned that at her hospital 0:10:48.400 --> 0:10:52.559 they actually won't let the doctors perform any complex procedures 0:10:52.960 --> 0:10:56.400 or surgeries overnight unless it's an emergency. If someone comes 0:10:56.400 --> 0:10:58.760 in with the gunshot or you know, a stab wound, 0:10:58.920 --> 0:11:01.240 then they have to do something thing. But if it's 0:11:01.280 --> 0:11:03.760 a surgery that they can push off till the morning 0:11:04.320 --> 0:11:06.520 or daytime, you know, they will try to do that 0:11:06.600 --> 0:11:09.320 rather than operate on someone in the middle of the night, 0:11:09.440 --> 0:11:11.320 just because of the risks involved. 0:11:11.640 --> 0:11:14.959 So I think it's important to recognize that some people 0:11:15.000 --> 0:11:17.520 do great at night. That's sort of where they really 0:11:17.559 --> 0:11:20.640 perform well, and they're just naturally better at night, and 0:11:20.720 --> 0:11:24.640 some people don't. So my background is pulmonary and critical care. 0:11:25.320 --> 0:11:27.040 And so then when I would go into the ICU 0:11:27.360 --> 0:11:29.600 in the middle of the night, you write a little 0:11:29.600 --> 0:11:35.400 adrenaline so that to kind of combat the sleepiness that occurs, 0:11:35.440 --> 0:11:37.240 and you have to be sharp, and I think you 0:11:37.840 --> 0:11:41.520 push yourself to be sharp, if that makes sense. You know, 0:11:41.679 --> 0:11:45.480 people in these fields are usually high achievers, high performers, 0:11:45.480 --> 0:11:47.360 and they put a lot of demands, like I'm sure 0:11:47.760 --> 0:11:51.240 you know in the er that adrenaline also helps. 0:11:50.960 --> 0:11:54.520 You, right, And there's been a lot of research on 0:11:54.760 --> 0:11:59.120 this topic of sleep deprivation among healthcare workers. So, for example, 0:11:59.440 --> 0:12:02.400 I saw that the British Journal of Anesthesia published a 0:12:02.440 --> 0:12:05.800 study that found more than ten percent increase in life 0:12:05.840 --> 0:12:08.959 threatening events that happened in surgeries that were performed at night. 0:12:09.400 --> 0:12:09.640 Yeah. 0:12:09.679 --> 0:12:13.520 Well, and it's risk of operator error, but also support 0:12:13.600 --> 0:12:16.680 in a hospital if something goes bad, you're minimally staffed 0:12:16.720 --> 0:12:20.160 at night. And so we used to have this lore 0:12:20.360 --> 0:12:23.640 in the world of pulmonary that if you have fluid 0:12:23.679 --> 0:12:27.680 around your lungs, it needs to be taken out before 0:12:27.920 --> 0:12:29.000 the sun sets. 0:12:29.120 --> 0:12:30.800 Was kind of what we were always taught. 0:12:31.440 --> 0:12:33.360 And then it turns out if you start doing these 0:12:33.360 --> 0:12:35.840 things at nine o'clock at night or ten o'clock at night, 0:12:36.200 --> 0:12:39.200 when no one else is in the hospital, that's not 0:12:39.240 --> 0:12:42.880 great for patients. Yeah, because then you may convert it 0:12:42.920 --> 0:12:45.880 into an emergency procedure or something like that, and calling 0:12:45.880 --> 0:12:49.800 people in from sleep, right, calling people in from their 0:12:49.800 --> 0:12:53.200 beds to help you. And so I applaud where your 0:12:53.240 --> 0:12:55.360 sister works that they recognized this. 0:12:59.320 --> 0:13:01.280 We'll be right back after a brief message from our 0:13:01.320 --> 0:13:11.920 partners at Mattress Firm, and now back to Chasing Sleep. 0:13:15.600 --> 0:13:18.520 Throughout our series so far, I've learned a lot about 0:13:18.559 --> 0:13:23.120 how sleep impacts our physical and mental performance and our endurance. 0:13:23.640 --> 0:13:26.840 I've deepened my understanding of how stress and anxiety can 0:13:26.880 --> 0:13:30.280 adversely impact our sleep as well. But speaking with George 0:13:30.280 --> 0:13:33.720 and Seema gave me a completely new perspective on just 0:13:33.720 --> 0:13:36.559 how much sleep impacts our overall and long term health. 0:13:39.320 --> 0:13:40.200 You know, it's so funny. 0:13:40.280 --> 0:13:42.520 We talk a good game in our world of sleep. 0:13:42.600 --> 0:13:43.679 Right we're saying, yep. 0:13:43.520 --> 0:13:45.240 You should be in bed at the same time every 0:13:45.320 --> 0:13:46.040 night and get. 0:13:45.960 --> 0:13:49.280 Seven to nine hours of good restorative sleep. And so 0:13:50.000 --> 0:13:52.600 what we've seen over the years is sometimes people who 0:13:53.040 --> 0:13:57.040 are night owls, we call them delayed sleep phase coronotype, 0:13:57.080 --> 0:13:59.719 So just meaning that you're just biologically right, you like 0:13:59.760 --> 0:14:01.319 to say up late and you like to sleep in. 0:14:02.200 --> 0:14:05.400 Sometimes they will find themselves in a night shift position 0:14:05.559 --> 0:14:08.880 just because it sort of fits with their circadian rhythm. 0:14:09.400 --> 0:14:12.520 But not always. We do see that there is a 0:14:12.640 --> 0:14:16.400 higher risk of cancer in night shift workers. They did 0:14:16.400 --> 0:14:19.680 a study of nurses, for example, and they had a 0:14:19.720 --> 0:14:23.480 higher incidence of breast cancer. And so it's really it's 0:14:23.600 --> 0:14:26.040 kind of amazing. I remember years ago we were giving 0:14:26.040 --> 0:14:29.840 this conference and I reached out to a cancer researcher 0:14:30.240 --> 0:14:32.040 and I wanted to talk to her about, you know, 0:14:32.080 --> 0:14:34.720 how we think sleep is super important, you know, for 0:14:34.840 --> 0:14:37.200 cancer and that sort of thing, and she kind of 0:14:37.240 --> 0:14:39.840 laughed at me. She was very kind, but I thought 0:14:40.040 --> 0:14:43.160 we were so smart thinking about this, and she's like, oh, yeah, 0:14:43.240 --> 0:14:46.000 we've considered poor sleep a carcinogen for decades. 0:14:47.040 --> 0:14:50.200 So yeah, they were way ahead of us. 0:14:53.720 --> 0:14:58.160 As Sema says, poor sleep is a carcinogen, a mood destabilizer, 0:14:58.400 --> 0:15:01.960 and it causes many other issues and diseases. I wanted 0:15:01.960 --> 0:15:05.200 to learn more about the ways sleep is constantly affecting 0:15:05.200 --> 0:15:08.640 our health, so I asked Sema to explain the biology 0:15:08.640 --> 0:15:13.640 of sleep and everything that's happening inside us as we snooze. 0:15:14.400 --> 0:15:18.960 So rem is important for mood regulation, right, slow wave 0:15:19.000 --> 0:15:23.280 sleep or delta sleep. This is this lovely slow wave sleep. 0:15:23.360 --> 0:15:25.560 Kids get tons of this. This is where they where 0:15:25.560 --> 0:15:29.320 they grow, and where they you know, sleepwalk, do all 0:15:29.320 --> 0:15:33.080 of those things. That's probably important for us to download 0:15:33.080 --> 0:15:36.120 short term memory into long term memory. And then rem 0:15:36.200 --> 0:15:40.640 is important for us to organize and edit those memories 0:15:41.480 --> 0:15:46.720 that's just in the mind. And so if you can imagine, 0:15:46.760 --> 0:15:48.960 the brain has right all those little ups and downs 0:15:48.960 --> 0:15:51.920 and on a cellular level if you imagine it, and 0:15:51.960 --> 0:15:53.360 I'm going to borrow this from one of my. 0:15:53.320 --> 0:15:54.720 Colleagues, doctor Chuck Seisler. 0:15:55.040 --> 0:15:58.280 He was the the expert witness at the Michael Jackson trial, 0:15:58.520 --> 0:16:00.680 and this is how he described it. So if you 0:16:00.720 --> 0:16:03.240 picture it like a big city like New York City, right, 0:16:03.240 --> 0:16:06.240 You've got these big, huge, tall buildings, and then you've 0:16:06.280 --> 0:16:09.240 got these alleys, and all day long, the garbage truck is, 0:16:09.520 --> 0:16:11.920 you know, cleaning debris out of the alleys, right, and 0:16:12.040 --> 0:16:15.120 people are tossing stuff out of the windows. And so 0:16:16.120 --> 0:16:21.360 when you sleep, the buildings shrink and the alleys get 0:16:21.400 --> 0:16:25.680 really wide, and so all of that debris gets swept 0:16:25.720 --> 0:16:29.880 away much more efficiently. And when you analyze that debris, 0:16:30.440 --> 0:16:33.400 it is beta amyloid, which is one of the things 0:16:33.400 --> 0:16:36.560 that builds up in Alzheimer's right, And so sleep is 0:16:36.800 --> 0:16:39.960 really really important to that, you know, for all of that. 0:16:40.080 --> 0:16:43.200 So to your point about you know, why does sleep 0:16:43.320 --> 0:16:46.640 impact cancer growth and why does it impact ourselves? You know, 0:16:46.680 --> 0:16:49.800 we know it's important for immunity. We learned a lot 0:16:49.840 --> 0:16:51.800 with a pandemic, right. We know that if you were 0:16:51.840 --> 0:16:54.760 well rested the night before your your vaccine and the 0:16:54.840 --> 0:16:59.200 day before that you had better vaccine responsiveness, and probably 0:16:59.280 --> 0:17:01.240 just because needs to recover. 0:17:02.480 --> 0:17:04.680 Wow, So it's not just the long term, it's these 0:17:04.680 --> 0:17:08.320 immediate effects have an impact on your response to a vaccine. 0:17:09.560 --> 0:17:12.880 Fascinating analogy. So when we sleep and we have our 0:17:13.000 --> 0:17:16.320 very own sanitation department clearing the streets in our brains, 0:17:16.760 --> 0:17:21.439 think about what that debris entails. It's imperative that George 0:17:21.440 --> 0:17:24.080 has time to clear out those beta amyloid proteins in 0:17:24.080 --> 0:17:26.240 his brain so that he can get back to work 0:17:26.440 --> 0:17:28.840 and be on top of his game, saving lives and 0:17:28.920 --> 0:17:36.600 helping people when they need it the most. With so 0:17:36.720 --> 0:17:39.359 much of our health writing on sleep, I was curious 0:17:39.400 --> 0:17:42.720 about the unique obstacles that er workers like George face 0:17:42.880 --> 0:17:45.760 when they're trying to get adequate sleep. Battling this news 0:17:45.760 --> 0:17:48.879 button for an early morning shift is one thing, coming 0:17:48.880 --> 0:17:51.320 home when the sun rises, and trying to get healthy 0:17:51.320 --> 0:17:53.880 sleep in the middle of the day is an entirely 0:17:53.920 --> 0:17:54.919 different challenge. 0:17:55.400 --> 0:17:57.800 So it's actually easier to get more sleep during the winter. 0:17:58.320 --> 0:18:00.480 During the summer is when it's said it's artists and 0:18:00.520 --> 0:18:04.560 I have to keep the sunglasses on after an overnight shift. Actually, 0:18:04.560 --> 0:18:06.720 that's one of the big things on the way home. 0:18:06.760 --> 0:18:08.879 If I forget my sunglasses, I get really messed up 0:18:08.920 --> 0:18:10.639 because my circadian rhythm wants to be awake. 0:18:11.400 --> 0:18:12.560 So you got to keep it dark. 0:18:13.240 --> 0:18:15.920 And if you can get out at a time where 0:18:15.960 --> 0:18:17.520 the sun still hasn't come up, I try and like 0:18:17.600 --> 0:18:20.320 rush home as if I'm a vampire or something like. 0:18:20.359 --> 0:18:22.159 I have to get there before the sun comes up, 0:18:22.200 --> 0:18:24.040 because it can absolutely throw you for a loop once 0:18:24.040 --> 0:18:24.800 the sun comes up. 0:18:26.000 --> 0:18:28.600 You know, our impetus to sleep is driven by a 0:18:28.680 --> 0:18:31.800 couple of things. So one is that circadian rhythm right 0:18:31.920 --> 0:18:35.680 when we're biologically programmed to be awake and to fall asleep. 0:18:36.240 --> 0:18:39.480 But the other is what's called sleep pressure. So sleep 0:18:39.520 --> 0:18:42.520 pressure builds up from the minute you wake up until 0:18:42.520 --> 0:18:44.960 you go to bed. So if you are at your 0:18:45.119 --> 0:18:49.720 typical sleep schedule, they both peak to push you to sleep. 0:18:50.480 --> 0:18:53.240 But now when we're asking people to work night shift, 0:18:54.520 --> 0:18:57.919 these work against each other, right, and so then we 0:18:58.000 --> 0:19:01.000 have to accommodate. We need to drill just say, okay, well, 0:19:01.000 --> 0:19:03.320 how can we make sure that the sleep you're getting 0:19:04.359 --> 0:19:07.480 is as good as we can make it. And so 0:19:07.600 --> 0:19:11.119 we really focus on the sleep environment. Make sure the 0:19:11.200 --> 0:19:15.240 room is cool and dark, especially and quiet. 0:19:17.400 --> 0:19:21.080 So especially with these ever changing shift schedules and the 0:19:21.520 --> 0:19:23.480 on the job stresses that are the norm and the 0:19:23.760 --> 0:19:28.600 er George, what other tools are there besides caffeine? Can 0:19:29.000 --> 0:19:31.560 strategic napping, for example, help to bridge the gap to 0:19:31.600 --> 0:19:32.160 getting rest? 0:19:32.960 --> 0:19:34.879 Went on twenty four hour shifts. 0:19:34.880 --> 0:19:38.600 Now, we don't necessarily do this in the ers everywhere, 0:19:38.640 --> 0:19:41.119 but some more rural places do have to do twenty 0:19:41.160 --> 0:19:44.480 four hour plus shifts. During residency, I had to do 0:19:45.760 --> 0:19:49.160 ICU rotations that did have twenty four to twenty seven 0:19:49.200 --> 0:19:53.040 hour shifts. Doesn't sound possible and I didn't think it was, 0:19:53.119 --> 0:19:54.479 but somehow you make it through it. 0:19:54.560 --> 0:19:56.240 Now, one of the. 0:19:55.880 --> 0:19:58.360 Main ways was after the whole day to day was done, 0:19:58.400 --> 0:20:01.320 when everyone else had left you and somebody else and 0:20:01.359 --> 0:20:03.320 you would try and take shifts where you could get 0:20:03.320 --> 0:20:05.439 to nap or sometimes even get. 0:20:05.320 --> 0:20:08.639 To sleep like four hours, and it really helped. 0:20:08.400 --> 0:20:11.000 Because you had already been up since six am, and 0:20:11.040 --> 0:20:14.000 then it was about whether it was eight pm ten pm. 0:20:14.040 --> 0:20:15.560 You got to even sleep for two hours. 0:20:15.600 --> 0:20:18.760 It was lovely because at that time bed feels the 0:20:18.760 --> 0:20:21.560 best and you just want to lay down. Sometimes it's 0:20:21.560 --> 0:20:24.280 a little more difficult to kind of wind down and 0:20:24.320 --> 0:20:26.800 then you end up staring at the ceiling for a while. 0:20:26.840 --> 0:20:29.760 But to get that rest and again step away from everything, 0:20:29.800 --> 0:20:32.800 it was so necessary. I don't I'm sure there was 0:20:32.880 --> 0:20:35.280 sometimes that people couldn't do it because it's just too 0:20:35.280 --> 0:20:39.080 busy for those twenty four hours. But the exhaustion really 0:20:39.160 --> 0:20:39.760 takes a toll. 0:20:43.359 --> 0:20:45.639 And so now let's say, for like a healthcare professional 0:20:46.080 --> 0:20:48.320 who you know, maybe works in a rural area and 0:20:48.480 --> 0:20:53.480 is working overnight shift pretty consistently, what can napping do 0:20:54.000 --> 0:20:54.440 for them? 0:20:55.000 --> 0:20:58.479 Oh, so this is a really important strategy. You know, 0:20:58.520 --> 0:21:01.199 if they are on call twenty four hours a day, 0:21:01.040 --> 0:21:03.400 they can't count on being able to sleep at night, 0:21:03.440 --> 0:21:06.719 can they. And so it's important to have a strategy 0:21:07.040 --> 0:21:11.480 where if they do have some downtime, perhaps they will 0:21:11.520 --> 0:21:16.000 be able to nap. Now, normally a shorter nap is better, 0:21:16.480 --> 0:21:19.840 meaning twenty to thirty minutes, just because you don't go 0:21:20.000 --> 0:21:25.040 into all of the sleep stages. Right, But that's for 0:21:25.240 --> 0:21:29.560 people who are able to sleep at night, right. But 0:21:29.840 --> 0:21:33.920 for our er colleagues that work those twenty four hour shifts, 0:21:34.320 --> 0:21:37.320 probably the single most important thing is that they have 0:21:37.440 --> 0:21:42.040 a place where they can sleep that is away from 0:21:42.119 --> 0:21:45.040 the er, not far enough away that they can't jump 0:21:45.160 --> 0:21:51.560