Joe Rogan - The Sleep Loss Epidemic

They don't and you know it's not that easy either you know and in fact I've started to try and lobby doctors to start prescribing sleep and don't make the mistake that that's me suggesting You know prescribing sleeping pills. That's a separate stray sleeping pills are associated with significantly higher risk of death and cancer and I'm happy to speak about that too it was the one chapter in the book that I Think the the legal team of my publisher took took a very long long look at but I think Doctors to come back you to your point they on average only have about two hours of sleep education in the medical curriculum So one third two hours two hours one third of that this podcast has been two hours Yeah, that's fucking crazy. So is that frightening? That's terrifying and I bet you probably have laid things out better in this podcast than you would get in those two hours of education I I don't know about that, but I think I'll give you that credit if they could if they could increase that You know I'm that's not a desperately appealing for this you know it's a third of their patients life But they only get two hours of education and but the other problem is the medical industry itself by the way You know that residents that data you know junior residents working a 30-hour shift are 460 percent more likely to make diagnostic errors in the intensive care unit relative to when they're working 16 hours if You have elective surgery you should ask your surgeon how much sleep they've had in the past 24 hours If they've had six hours of sleep or less you have a 170 percent increased risk of a major surgical error such as sort of organ damage or hemorrhaging relative to that same surgeon if they had been well rested and then the irony here by the way is that when a Resident finishes a 30-hour shift gets back into their car to drive home. There is a 168 percent increased risk that they will get into a car accident because of their under slept state Being ending up back in the same emergency room where they just came from but now as a patient from a car crash You know it's we need to radically rethink the importance of sleep in education in Business in the workplace and in medicine to why do they do that to residents? It's a fascinating story So there's there's a chapter here in the book on this too It's a guy called William Halstead and he set up the first resident surgical program in the United States at Johns Hopkins University and He was known for being able to stay awake for these heroic lengths of time days on end This is incredible like superhuman strength Turns out that in later years after he died. There was a dirty secret that he was actually A cocaine addict that son of a bitch and here's what happened. It wasn't his fault early in his career he was examining the Anesthetic capacities of cocaine so you know if well, I'm not gonna say you know and you may have heard from Perhaps colleagues that when you snort cocaine you get a numb face. The reason is because it's it blocks nerves So like I said from colleagues Colleagues Never done cocaine I know quite a few people who have and they will you know They'll have this sort of numbness. It's the reason is because cocaine is also a nerve-blocking agent. Yeah like lidocaine lidocaine Yeah, we talked about this yesterday ironically on the podcast and about doctors becoming drug addicts The initial doctors have started doing lidocaine Halstead was one of them And so he became an accidental cocaine addict Wow, and then he was up for days He was up for days and He structured a program where he expected his residence to match him to go toe-to-toe with him Yeah, sounds like what a coke head would do come on man stay awake unbelievable And I think the story was that he actually knew that it was a problem he went to rehabilitation checked and under a different surname and one part of the Regiment for him coming off cocaine was to prescribe Morphine and at the end of the rehabilitation program. He came out with both a cocaine Addiction and a heroin addiction. Oh my god. And so now there's rumors, you know that he would get his shirts laundered in Paris, you know in France and You know they would come back and it wasn't just the white starch You know shirts that that were in the box that we were other white substances, too But that's you know, you ask a great question. Where did that come from? Where's that history the legacy seems to date back to William Halstead who was an accidental cocaine addict? And there we have then maintained that Inhumane practice in medicine, which is like So critical to be awake and aware and to be sharp you're cutting people open You're operating on people and think back to what we said, you know about being awake, you know You would never accept treatment from a doctor who started, you know Looking at your child who's sick with an appendicitis at 3m in the morning who then swig some whiskey and says yeah I'm gonna do the operation fine you would you'd go ballistic. Well, why do we accept treatment? You know after 20 hours of being awake, you're as impaired as you would be if you were legally drunk So unfortunately we placed young residents in this position Of you know acting and operating and decision-making under conditions of insufficient sleep One in five medical residents will make a serious medical error due to insufficient sleep One in 20 medical residents will kill a patient because of a fatigue related error One in 20, that's crazy. And right now, you know, there are well over 20,000 medical residents So if you have a hundred of them five are gonna kill people accidental deaths think about that number. That's insane If we were to solve the sleep loss epidemic in medicine, you know We could start saving lives and I don't know what it is. Is it just a you know, an old boys network? Well, we said well we went through it. Yes, so you've got to go through it, you know And there's the data now is so prolific, you know I write all about that and try to make a builder an evidence-based, you know Emotionalist cold case for sleep in medicine a sleep prescription for medicine as it were well Most people don't realize the requirements of residents have no and and they are they are literally, you know Beyond human capacity thinking that you know hubris and some degree of hours on the job is Going to be able to allow you to sort of you know cut short What took three and a half million years to sort of you know get in place, which is an eight-hour night of sleep That's just thick-headed, you know It's and I think the medical profession it may be at the stage where it's my mind is made up Don't confuse me with the facts Wow That that this is blowing me away I just don't understand how the very people that are working on the health of patients and fixing them and Repairing injuries and taking care of diseases Those are the people that are ignoring one of the primary factors of disease and errors and Cognitive function it's it's impairment. It's a travesty. I have a friend who's an ophthalmologist He tells a story about during his residency. He was is his back in the 80s and he had a pager He was on the toilet with a tray of food on his lap because he didn't have time to eat and go to the bathroom So he's eating food and he fell asleep and then his pager went off. He's like fuck my life How many warnings how many warning bells do you need to tell you that you're in a deleterious state if you're With your trousers around your ankles with food all over your face And yet you're in the deeper stages of non-rem sleep and he's a guy who's working on people's eyes. Yeah, it's crazy Yeah, I mean and it's you know Sleep is equally absent for the patient in the hospital. You know setting we know that somewhere between 50 to 70 percent of all ICU alarms are either unnecessary or Ignorable, you know and the one place where you desperately need the Swiss Army knife of health That is a good night of sleep is the one place where you get at least which is on a hospital ward We could we could exit people out of hospital beds earlier The data is already there for the neonatal intensive care unit. They used to leave bright lights on 24-7 right and that would prevent sort of the signaling for sleep and wake and sleep and wake and that cycle is critical if you regularize sleep Sorry, if you regularize light in the neonatal intensive care unit Those infants ended up having higher levels of oxygen saturation because they were sleeping better Their weight gain was dramatically increased and they ended up exiting the neonatal intensive care unit five weeks earlier Whoa Simple things, you know, why don't we do something like this in medicine when you come in onto a hospital ward? You get this on an international flight travel for free earplugs face mask Even just that by itself could help people to start get better sleep Next on the hospital admission form tell me when you normally go to sleep and when you normally wake up and to the best Of our ability we as doctors will try to sort of you know Manage your health care around your natural sleep tendencies if we could do that, you know sleep is is The elixir of life it is the most widely available Democratic and powerful health care system I could ever possibly imagine Why aren't we leveraging that and taking it that's one of the greatest hacks that medicine could actually, you know Inflect stunning How is this being received like by doctors? Are they reluctant to listen to you? I mean, what is happening with all this data and your passionate cry for extra sleep or more sleep or the proper sleep I should say it's starting to happen I mean when the book came out which was sort of the hardback came back out in back in October and and Some people started to give pushbacks sort of in the medicine realm, you know There was some concerns about continuity of care that if you keep switching residents out every 16 hours That you wouldn't have continuous patient care and that was a problem Well, there are other medical training systems. For example, France Sweden, New Zealand They do this all the time. They do not allow their residents to Undergo anything longer than either a 14 or a 16 hour shift They train their residents in the same amount of time or less and if you look at the rankings of their medical health systems Around the world. They rank far higher than the United States So you can't tell me that longer work hours for residents, for example are necessary to train good doctors The evidence just isn't supportive. So I've had some pushback there But for the most part, I think people are receptive once they know the information and I think I'm the I've been the someone Who's been to blame here? I've known this evidence for you know, I've been doing sleep research now for 20 or so years We are with sleep where we were with smoking 50 years ago We had all of the evidence about the deathly carcinogenic cardiovascular disease issues, but the public had not been aware no one had adequately communicated the science of You know smoking to the public the same I think is true for sleep right now That's part of the motivation for why I wrote the book why I've been doing or trying to do a lot of publicity I'm a very shy person and I don't like being in the spotlight But I feel as though there is a mission that whose voice has not been actually gifted yet And I wanted to try and help and be a sort of a sleep diplomat I mean, that's why I chose the handle on social media trying to be there as an ambassador for sleep and Now once people start to understand the science as we've spoken about for two hours Then people start to actually realize it's not the third pillar of good health alongside diet and exercise It's the foundation on which those two other things said, you know, for example if you're dieting But you're not getting sufficient sleep 70% of all the weight that you lose will come from lean body mass muscle and not fat Your body becomes stingy in giving up its fat when it's under slept So once you get this information out there things are starting to change I've started to have some discussions with the World Health Organization They seem to be very interested now in getting getting to grips with sleep I'd love to speak to first world governments though When was the last time you saw any first world nation have a government supported public health campaign around sleep? I Don't know any we've had them for you know, drink driving for risky behaviors, you know for drugs for alcohol for healthy eating Sleep should be a part of that equation You know I want to lobby governments to start to instigate this and it will save them millions of dollars the Rand corporation Did an independent survey two years ago on the demonstrable cost of a lack of sleep to global economies What they found was that a lack of sleep cost most nations about 2% of their GDP of the gross domestic product Here in America that number was four hundred and eleven billion dollars caused by insufficient sleep Solved the sleepless epidemic you could almost double the budget for education and you could almost halve the deficit for health care Wow