Episode 2: Sleep, Shift Work, and Being On Call
Within this episode, Dr. Trudy Gilbert-Eliot discusses the importance of sleep on health, along with strategies for ensuring good sleep hygiene in the midst of shift work, and spouses being on call.
- Walker, M. (2017). Why we sleep: Unlocking the power of sleep and dreams. New York, NY: Scribner Press.
- Huberman Labproduced several great podcasts doing a deep dive into sleep.
- Matthew Walker has been on several podcasts including “The Science of Success”, “Talks at Google”, “Finding Mastery”, and “Joe Rogan”.
CASAT Podcast Network today.
We get to talk about sleep shift work and being on call and ways that family members can support first responders and really starting to understand how how does the family dynamics work and how can the families also be supported in this shift work?
So we’re excited to talk with you today, Dr. Gilbert-Eliot.
Uh so what are the most important facts about sleep that our listeners need to be aware of?
So I love to talk about sleep.
So this is a topic every single time somebody comes into my office, they’ll get used to pretty much after the third or fourth session, people will sit down and say, okay, I got about, I got 7.5 hours last night.
So they’ll start just reporting on it because they know it’s so important, especially when it comes to trauma, but in particular because of the type of work, first responders do, sleep is going to be an issue and it’s going to be a topic that’s really important for families to have an ongoing regular discussion about.
So, first of all, most people need somewhere between 7.5 and nine hours.
If if someone were to tell you that they need less than 7.5, there probably absolutely fooling themselves or they’ve read something that says that there’s a rare person who needs less and but what what what we know is that you’re going to, you’re going to suffer if you are getting much less than 7.5 and then also just learning yourself, which we’ll talk about a little bit later on in this podcast.
So, um so my favorite study about this just to illustrate the, just some of the facts about sleep.
So there’s this this study and I should, I can look it up and then send you a link to like what, where, where the study was done.
So they basically divided people into four groups.
So the first group, they had them stay awake for 72 hours and they tested them on a regular basis to see how their performance was, each like our two hours whatever.
During that 72 hours of being kept awake.
The second group was kept awake for the only got four hours of sleep at night for two weeks.
The third group got six hours a night for two weeks.
And the fourth group got eight hours of night for two weeks.
So that’s the four groups.
So this is what the results found.
All this testing that they did with these four groups of people eight hours of sleep at night.
The people actually were able to maintain a very, very stable and an almost perfect performance across those two weeks every single day of those two weeks.
Um the thing that they started to notice about the other three groups is they actually figured out that they were doing this thing called micro sleeps.
And what that means is that, is that a person is actually technically falling asleep for just mere seconds, but they are not aware that they have actually fallen asleep.
So they call them micro sleeps.
And so what they, what they discovered with these two groups is so at, So at 24 hours for the 72 hour group.
At 24 hours awake, their lapses in concentration.
So they’re missed responses increased by over 400%.
So that’s kind of like mind blowing.
So then there’s the four hour group, four hours a night group.
So after four hours of sleep for six nights, the four hour night, Four hour a night group was performing as if they had been awake for 24 hours straight.
So that’s just six nights in.
And by day 11 as if they were awake for 48 hours straight and their performance continued to Degrade every day thereafter.
And they believed how they continued the experiment, they would have continued to degrade The six hour a night group.
Also experienced severe Um degradation of their performance.
And by day 10 they were performing as if they’ve been awake for 24 hours, this is six hours a night, which is many of us know, people who only get six hours a night of sleep and they think they are performing really, really well.
And that was also one of the most important takeaways from this group of experimenters is they said they had actually asked this group of six hours a night people in particular, how do you think you are performing and what their response was?
Well, I noticed I wasn’t doing good like the first few days, but then I adjusted and then I did just fine.
That was their perception.
So that’s even more important is the fact that when we’re only getting six hours of sleep at night, we are performance continues to degrade.
But we’re the only ones who don’t know it because we all adjust.
And that to me is really, really, um, that’s really a problem is because we have an inability um, to really recognize how poorly we’re performing every time I assigned sleep as homework assignment therapy.
And I have people come in a week later, two weeks later, whatever their scheduled time is, they were saying I have so much more energy and there’s almost like shocked.
Like, well, yeah, that’s what sleep is doing for you.
So the main thing is is that to really recognized too, is there really are no nocturnal humans.
We don’t have, we don’t have any physiological adaptations to be nocturnal.
It isn’t like if you’re on graveyard for four years, you’re eventually going to grow a second eyelid, that just doesn’t happen.
We’re going to only have, we are all on either a daytime circadian rhythm or what would really amount to a swing shift circadian rhythm.
There are humans that have that.
But nevertheless both of those rhythms still sleep during the dark.
And so whenever you’re on a graveyard shift you are going to have additional struggles because we don’t have adaptations to sleep in the graveyard and then obviously in fire for firefighters, they’re up for 24 hours, 48 hours, 72 hours depending on their shift.
And so they are going to have some real struggles as far as that, just really broken sleep.
So sleep does a lot for us, it aids us in learning attention concentration actually, and I could go into it, but if you end up reading a little bit more about sleep, you’ll end up finding that when you have enough sleep deprivation, you are actually performing like even in driving, much, like if you were actually legally drunk, that’s how poor your reaction time is, when your sleep is impacted.
Um There’s actually less injuries related to um like even like just being a regular person who exercises, if you don’t get enough sleep, you’re much more likely to injure yourself just going to the gym.
Um So for example, a research study found that athletes who received about nine hours of sleep nightly had a 15% chance of injury, but those who only got six hours of sleep regularly had a 75% chance of getting injured in the course of their workouts or in their performance in their their sport.
Um if you only get 5-6 hours of sleep, you’re twice as likely to get in an accident, but if you get less than four hours of sleep, your odds Um actually increased 12 times that.
So that’s how much it impacts.
And so and then obviously, you know, there’s some other things that sleep does really nicely for us.
It does help with emotion regulation.
So if you’re not getting really good sleep, we tend to get really moody and grumpy and irritable.
Those kinds of things.
You’re gonna forget a lot, you’re gonna make a lot more mistakes which you then have to correct and you’re already frustrated by the mistakes and now it’s really going to be difficult.
It does tend to affect our immune system over time and um and also some other issues like diabetes, obesity, cancer, heart disease.
Those already, those have been linked with poor sleep, poor lifelong sleep.
And um and certainly these are not meant to scare people.
These kinds of facts.
They’re really meant to underline the importance of getting sleep that can end up increasing your positive functioning.
It’s such a it’s so great because it’s free.
It isn’t like you have to go someplace to buy a bunch of it in order to actually access.
It is great.
It’s something that you can just naturally do on your own and you can learn to be better and better at it.
I love sleeping.
I do to sleep is a non negotiable for me.
I’m a nine hour type of girl.
Just it’s yeah, can’t can’t function without my nine hours when we, when you talked about broken sleep for, um first responders, firefighters, etcetera.
Um what are some of the homework um, suggestions you give for how to deal with these broken sleep patterns that are inherent in the work.
So I would say more than anything, um, for for people who have broken sleep, you end up having to be a lot more clear and intentional when you do have time that you actually can get sleep.
So even if at work your sleep is poor, you end up having to find a process when you’re at home to make sure that you’re really clean about that process when you’re at home, you may not be able to be when you’re at work obviously.
Um so, and obviously families really can do an awful lot to help in this regard and and then also to make sure that the families are more optimized as a result of the first responders getting enough sleep and then obviously the family as well.
Um, so it’s important to create really good sleeping spaces, so making sure that the person, especially if they’re day sleeping, for example, for a for a person who’s on graveyard shift, they’re going to need a really dark room.
So you’re gonna have to get those blackout curtains and make sure a lot of people end up just trying every different kind of face masks that they can find and they will sometimes hit upon one that’s really good.
And it’s interesting when you can hear officers or firefighters who talk about the face masks, they like to find it has to be quiet and so some kind of noise canceling sort of situation.
Some people do use your earplugs as a result of day sleeping.
Also temperatures are really important, which is really a huge part of sleep hygiene.
Your body actually needs to physiologically be at a lower temperature.
So circadian rhythms, we talk about those like as far as light and dark, but also circadian rhythms have to do temperatures.
So throughout the course of a day, our temperatures actually ebb and flow and one of our lowest temperatures is during our sleep cycle.
So we need to find ways to lower our body temperature in order to go into deeper sleep, which is why that room needs to be much cooler, which might mean it needs to be on a separate air conditioner or it needs to have some kind of separate cooling ability in the room that the day sleeper sleeps in because that will mimic in a sense nighttime and that lowering of temperature.
Um Also, a lot of people use sound screens, if you don’t know what those are, you can actually download one onto your smartphone.
They actually have lots and lots of ones to choose.
Um they are can be really useful to block sound that.
So you put the sound screen really near your ear and it will block sound a little further away.
So people will sometimes use those in addition to some kind of ear coverings.
Also I think it’s really important as far as families go that everybody determines like quiet hours and that that may necessitate getting super creative.
Um for example, I know one family who I thought was so brilliant because it just speaks to their desire for everyone to do well is they actually had the first responders sleep at the in laws house or their own parents house.
So their parents at all, adult Children, the two parents were at work, so they would actually just go over to their parents, sleep in the spare room and then come home and I thought, gosh, that was so clever for them to have come up with that as a solution because that way it wasn’t interfering with the rest of the family.
And everybody’s saying how come dad’s not coming out to play or how come mom’s not coming out to play, they were able to solve the problem that way.
So some families actually get really quite creative of even having the first responders sneak in the house and nobody knows they’re there and then go into that sleeping room.
That is kind of just a room that nobody uses anyway and then um and also you really want to work on work at first working on on quality of sleep over quantity of sleep at first because quantity is something you need to be working on, but you also want to be over focusing on quality.
Obviously we need that 7.5 to 9 hours, depending on the person, but you want to make sure that you’re also considering it’s not just being in bed for nine hours, it’s the quality of sleep that you’re getting.
And to actually find some ways to figure out um ways to increase that quality.
How what are some ways to increase that quality of sleep?
So so some of the some of the things that really speak most effectively to quality are all of the things that have to do with sleep hygiene.
So really what’s interesting is most of us and I actually even said something about, you know, it’s a natural thing to do.
Yes, it’s natural because you can only keep a person awake for so long and they’re just going to they’re gonna just have to fall asleep because we have to it’s it’s essential part of our survival.
But there are some things that a lot of people think it should just be automatic.
Well it isn’t so we actually have to train ourselves to be good sleepers in a sense, most of us who are not natural athletes, we have trained ourselves to do whatever we do for exercise.
It wasn’t it wasn’t natural to us.
So the same thing with sleep, sleep is not always as natural as we would like it to be.
So we have to train ourselves to be better sleep.
Some things we do is we want to have a really, really clear sleep preparation routine so that our brain is clearly signaled that we are about to go to bed.
So we do this always with babies, you know, we’re sleep training babies out of complete desperation usually, but we definitely we know to do this right?
So we get really clear like, and we’re going to take bath time and then we’re going to tell a story and then we’re going to, so we have these things we do in a row that is signaling to the baby, it’s time to go to bed.
Well we don’t outgrow that we stop doing it, but we actually don’t outgrow it.
And so anything that we can do that really signals the brain effectively, we’re about to go to bed And we usually consider the sleep hygiene routine is that 45 minutes to an hour before you go to bed because what you’re trying to do is you’re trying to wind down so you’re trying to slow down, you’re trying to relax, you’re trying to do activities that would avoid noise and avoid light.
Light is in a sense your absolute enemy to sleep.
And that includes our phones, unfortunately television, which many of us have terrible habits with, but those things are not your best friends as far as quality of sleep and then also things that prepare you for good sleep.
An interesting one is a hot shower and a lot of people take their showers in the morning.
And what’s interesting is they take the hot shower in the morning and they can’t figure out why it doesn’t wake them up is because the hot shower, the hot shower actually makes you sleepy because it because it it lowers your internal body temperature.
That’s the whole purpose of the hot shower.
So if you really want to wake up you take a freezing cold shower in the morning.
And then what happens is it increases your internal body temperature which then wakes you up.
So it’s actually the opposite.
So a hot shower right before bed will lower that internal body temperature which will actually help you sleep more deeply because it it does a very rapid lowering of your body temperature.
And then also any of the other things that people do.
Like some I always call, I read a boring book and actually it’s not they’re not boring books but they’re usually not books that I like.
I can’t put down.
I don’t read those kinds of books before bed.
I read something that is I like to read but that I can easily put down and pick up again the next night and then all and like things like like maybe a slow little yoga routine or a nice meditation before bed can actually help you wind down and sleep better.
Also, another thing that’s super important for quality of sleep is you need to go to bed within one hour of the same bedtime, seven days a week and that is so difficult for many of us.
But when your first sleep training yourself, it’s really good to adhere to that strategy because you’re gonna notice like, wow, it gets easier and easier.
You may wiggle around with it once in a while, but I think after a while you get some real respect for it because it’s wonderful so you don’t mess around with it as much.
Um also you really want to avoid alcohol or caffeine actually, nicotine and chocolate, interestingly too close to bedtime because those things can actually make it so that you cannot fall into deep enough levels of sleep.
Each of those substances have different chemicals that are introduced into the body that disrupt different phases of sleep.
For example, caffeine disrupts the fall asleep part of sleep.
Now you may be able to fall asleep, but you don’t go into deep sleep, you stay in shallow sleep, so until enough of the caffeine wears off because it actually blocks adenosine receptors in the brain, which is, and that’s that fall asleep chemical that we need um if you have insomnia, which I’m not going to be talking about today, that’s something you can look up, there’s many different types of insomnia, but if you have any of the types, you really want to avoid naps.
Some people love naps, that’s kind of their little indulgence.
But if you’re having a hard time getting a really restful night’s sleep, you want to avoid naps at first and then maybe reintroduce them to see if you can take one and have it not go south on you and disrupt your evening sleep.
And also you have to do, you do want to beware of exercise too close to bed because there’s some people that activates us so much and again it increases our body temperature, which is why we have a hard time falling asleep.
So we have to, some people are more, are more vulnerable to that than others.
That’s kind of a personal thing.
I am one of those people.
And so um you wanna look at that.
And also another thing that can really be helpful is get some exposure every day.
And I’m not talking about some burn or uh or like lay out in the sun every day.
It’s just being out in the sun and looking towards the horizon as the sun is coming up will actually reset your circadian clock.
So it will, it will have a tendency to make you sleepy earlier in the evening.
So, so so you actually want to be physically outdoors, it’s very difficult to get enough of that, like staring outside through a window.
And we’re actually very fortunate here in Nevada and not in every place like here, you could probably get a good dose in five minutes, 10 minutes max, maybe in some other places where there’s a lot of cloud cover, it’s going to be a little bit more difficult.
But that’s an interesting one that uh, and you can actually utilize this little science is what it really is, neuroscience to um, to help you with jet lag too.
But that’s a, that’s a whole different topic, which I’m not good at.
So someone else can can do that podcast.
I love this idea of sleep training ourselves just like we would a baby.
That’s such a great analogy.
It’s, it’s interesting how it seems like it’s more, there’s a lot of, of things that are suggested, but you have to find your kind of bandwidth in that, like what works for you and your adjustment.
But I love how when we had kids, it was always, what is it bath bottle bed?
Bath bottle bed, right?
And you think they grow out of it at some point, but really like, we need to do that something similar.
Maybe not, maybe it’s not bath bottle bed, but something similar and find kind of what works for you in that in that place.
So, as you mentioned on call families need to be so much more intentional.
What are some good tips to help them with this additional pressure that they face.
So as a family therapist, I’m a really big fan of family meetings and I think it’s one of those things that sometimes in families, we, we struggle a little bit if, if, if we aren’t openly talking about something.
So it ends up sort of being the elephant in the living room to a certain degree or something that we regularly complain about.
But we don’t actually sit down and try to problem solve it.
And, and to be able to actually have that as a topic, sort of people’s physical needs within the family and be able to have an ongoing conversation about like how are we doing, how are we doing and adding that sense of we that this is about optimizing the family as a whole.
It’s not just optimizing one member, but if if like, let’s say it’s the mom in the family and she’s working graveyard, if she’s getting really good sleep, she’s going to be so much more available as a mom, she’s going to be more available as a friend as a spouse, as a daughter herself.
And so it ends up, it ends up being a win win for everyone.
So having that as an open conversation and then being able to work through any of the glitches about like, let’s say quiet time or, or maybe it needs to be reworked that, that the family member sleeps in an even different room than they normally sleep in because it just works out better for the family, having that being an ongoing conversation through a, even a formal family meeting would be really good.
Also for families that do work shift work or on call work, it’s really important for them to create some really flexible rituals of connection so that the on call family member will have quality time with the family.
So that’s gonna necessitate a lot of thoughtfulness and a lot of planning.
So like, let’s say for example, you’re used to that you’re one of your rituals of connection is family dinner, which is a really lovely connection way to connect with everybody.
But maybe that family member is just not available for dinner.
A lot of, a lot of the nights of the week, it may be that you have to get a little bit more creative about finding some ways of connecting in a maybe when they’re just on their on call schedule or it might be that when they are Um back home, like let’s say that they had a, their firefighter and they had a 24 or 72 hour, shift whatever it ends up being and that you come up with some kind of really nice transitional like ritual of connections.
So you kind of reconnect in this really nice way, which could even be like, okay, we all do this really nice breakfast together as soon as he gets back home or whatever before he goes to bed or that we, that’s our time that we um, And that, that first 90s back, we always have a movie night or something like that.
So you kind of make it special after.
There’s been this time where there’s been a gap in that person being at home so that you end up creating sort of just a unique ritual of connection.
So you guys, you get to really reconnect.
Um and also I think for families and this is another one of those, it’s an ongoing conversation for families is we have to really get aware of our own expectations of others.
And I think this is just true of all of us or maybe trying to be healthy people is, but to to recognize an expectation in your own head is one thing which is amazing, but then to actually speak the expectation and then to see if it’s even something that is manageable, there’s a little saying that that goes like this is an unspoken expectation is a premeditated resentment and I’ve always felt like that is so true, it’s like so we will have these expectations of another person like oh you know when they come home it’s going to be X, Y, Z, but we never actually expressed the expectation and then we are so upset and so angry with them that they aren’t performing like we would like them to, so to me if you know, I’m just a big fan, if you want to surprise birthday party, asked for a surprise birthday party because if that’s your, if that’s really what you want and that’s just, you know, so so act surprised, but at least you asked for it and at least you’re getting what you want.
And there isn’t some kind of a sort of a setup within any of your relationships.
And also when we share those expectations within her family, we’re just opening up amazing communication between each other and so that we can share our expectations of our Children share expectations of each other and that it just ends up being so much, so much healthier to have that open communication.
I’ve also seen um first responders and families who um you have your own internal expectation of, oh, I better get up so that I can spend more time with my family and not sleep as much.
Do you have you seen that?
And do you have any advice for that?
And I think that’s where this really comes in, is that sometimes we end up having to know sometimes the expectations obviously of others, but also of ourselves and then check in with other people, Is this what you is this?
Would this really make it better?
Is this just me putting a lot more pressure on myself for a lot of internalized guilt in some way that I am, I’m not a good enough, you know, fill in the blank in some way or another.
And that way we end up having that awareness and again, it’s it isn’t always easy to be aware of how our own brain is ticking along, but, but sometimes our own emotional state can be a guide that way.
So if I’m feeling bad a lot too, then check in with myself what have I been thinking?
Because usually that’s they’re usually connected actually.
They’re always connected.
Well as we wrap up this episode, um any other information or resources that you’d like to share with our listeners today.
Actually, if you really want to do a deep dive into sleep, there’s a great book by Matthew walker and he is a neuroscientist and his book is titled Why We Sleep unlocking the power of sleep and dreams.
And he’s actually a great writer.
It’s actually my, my evening reading.
I’m almost finished with it right now, but he’s a great writer.
So even all of the research he cites its very, very intriguing and very interesting.
It makes you really want to get better at it.
There’s also some really good articles out there.
There’s someone’s like CBT, which is cognitive behavioral therapy for insomnia.
So if insomnia is your nemesis, there are some really good treatments out there, but there are also some really good information online and there’s also a sleep foundation.
It’s an organization that has just dozens and dozens of articles on all different aspects of sleep, including if you want to know more about sleep hygiene if you google sleep hygiene, they have just some really, really good information about some of the things to work on and like Daniel had said there’s some, you have to crack your, crack the code of yourself.
You have to figure out like what is the sort of the perfect mix of activities or things you do that ends up enhancing your sleep.
So it’s just really understanding yourself that way.
And there’s some really great podcasts out there too in particular, oddly enough, as we had already decided on this topic of sleep.
Um dr Huberman who’s a neuroscientist at stanford Actually started a podcast in his 1st 4 episodes were all about sleep.
Those were his first four and they were off the chain.
They were amazing.
So that would be if you can, he’s very, very, very densely informative and so your, your vocabulary will increase as you listen to him.
So it’s really enjoyable.
But it’s, you’ll really learn a lot about sleep and you’ll, you’ll get re re devoted to it.
And then also Matthew walker has been on a whole bunch of podcasts.
If you want a really brief kind of sense of some of this stuff, you could just google, Matthew walker podcasts and he’s been on dozens and dozens.
He’s and he’s very, very, very well spoken, Very entertaining.
We can put those in the show notes.
Okay, Trudy can you tell us just some maybe some action steps that folks could take if they’re wanting to work on their sleep and just like a specific routine they could do or anything you have on, on really how to get this under control.
Yeah, some, some action steps I would really suggest for families is you want to be evaluating your sleep hygiene.
So you want to determine, in a sense, even three new habits you can incorporate into your sleep process over the next few months in order to improve the amount and quality of your sleep.
So you just want to just add some habits.
So like even if it’s just some small thing, like taking that shower before bed and then just start paying attention to how well you sleep.
Um also you really want to take a deep look at that alcohol and caffeine use.
I will usually ask folks who come in and see me.
I’m going to ask those questions and I usually tell people you have to stop drinking the coffee probably by noon if you’re a regular nighttime sleeper because that’s about as long as you really want to and then just notice what it does to your sleep.
Notice notice that for yourself, um because you do want to have that restful sleep, not just you’re in bed and you’re technically asleep but you’re not doing deep sleep.
Also, you might want to consider meditating before bed when, if you’ve never never meditated before.
Trust me, you’re gonna suck at it because I sucked at it really, really badly when I first started, I don’t even know if I could cobble together 30 whole seconds of attention on it, but all you do is you just let you know if your brain drifts away, come back to it.
There are lots of apps for meditation, but my favorite honestly is Youtube.
And so I just Youtube guided meditation and hundreds and thousands of them pop up and so I’ll pick one that’s maybe 15, 20 minutes long.
But I’m only gonna do maybe 5, 10 minutes of it and it’s just so that you can learn to slow your brain down.
That’s the whole process, which can actually really enhance sleep.
And then also schedule regular time to check in with each other to make sure everyone in the family feels supported physically and emotionally.
During due to those fluctuating very, very different schedules.
I love that.
So folks that are listening and if this is something you want to tackle, I imagine most people sleep is something you want to tackle, taking those action steps which we can have listed in our show notes as well.
Um and working through those and working through them as a family, it seems like that theme comes up over and over and checking in.
That’s great, Thank you so much.
Trudy, you’re welcome.
This was such a informative and I’m thinking to just, you know, I can’t imagine dealing with sleep and working as a first responder, I mean it’s sleep is difficult enough, you know, it’s whatever a normal life is.
But you know, we talked about with college students and working families and how difficult sleep is, but then you add in the night shifts and the long shifts and the on call and and so such a a massive, you know, topic to tackle.
But also I think just like you know you were saying it’s important to talk about it.
There’s a lot of myths around it and I think the information you had today was was great.
And just for me it’s always I what I love about these podcasts is it’s a place to start digging too.
Like I’m getting tons of information from what you’re sharing, but I’m also taking notes.
I’m like okay, I’m gonna read this and look here and look here.
Um and so really fascinating.
Thank you so much for everything you brought today and all the resources.
Um it was good.
I enjoyed it.
Yeah, thank you so much.
It was fun.
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