I am doing two episodes on sleep–how to get it, how to get enough, and how to maximize the quality of your sleepy time. So, today I'm chatting with two awesome physicians from the precision medicine company, Wild Health. They're using the latest in medical science to build a new approach to healthcare that is personalized, data-driven and lifestyle-led.
Dr. Mike Mallin is the co-founder and chief science officer at Wild Health, and he is responsible for concepting and building their proprietary algorithm, Clarity
Dr. Mike Stone is chief education officer at Wild Health – he developed their precision medicine fellowship and educational programs for physicians.
Given their backgrounds in the ER and current work in precision medicine, I wanted to dig into brain health and sleep, specifically as it relates to shift work, and I think a lot of you will be interested in what they had to share…
About Wild Health
Wild Health is a precision medicine company founded in response to a broken medical system. Using their passion for preventative health, the physician founders developed Clarity – the world’s first true precision medicine platform. Through advanced machine learning, they combine DNA analysis, biometrics, microbiome testing, and phenotypic data to give you a blueprint for truly personalized health. In their most recent data analysis of 2,200 patients they reduced A1c by 31% in diabetics with A1c >9.2 and 19% in those with pre-diabetes (A1c >5.5), fasting insulin by 42% and 23%, respectively, and insulin resistance overall by 35% in all patients. Inflammation decreased 22%, LDL-P by over 20%, and Triglycerides by 26%.
Wild Health also offers training in their proprietary method of genomic based medicine through the Wild Health Precision Medicine Fellowship – a robust 12 month curriculum for clinicians who want to move from providing sick care to true healthcare with the latest innovation in medicine. If you’re interested in learning more about Wild Health, engaging in one of their courses or licensing their software, sign up on their website or reach out at support@wildhealth.com.
Check their stuff out–life changing! And again they did not pay me for this ad, they are just my buddies and doing amazing work.
What we Talk About
Optimal Shift Scheduling
Should you Block your Nights?
The Day before the Night Shift
Strategies on the Night Shift
Getting Home Safe after the Night Shift
The Day After the Night Shift
What I am Speaking about on Part 2
Part 2 will be a soup to nuts deep dive into sleep hygeine and sleep correction. I have spent months researching optimal sleep for my coaching clients and I want to braindump all of that in one enormous episode. If you have any ?s you want answered, put them in the comments below or hit me up on twitter.
Additional New Information
- Resident Work Hours ( N Engl J Med. 2019 Mar 7;380(10):905-914. doi: 10.1056/NEJMoa1810642)
- We are consistently exhausted
More on EMCrit
Additional Resources
Now on to the Podcast
- EMCrit 373 – Mike Weinstock with another Critical Care Bounceback: “Asymptomatic Hypertension” - April 18, 2024
- EMCrit Wee – Ross Prager on 10 Heuristics for the New ICU Attending - April 13, 2024
- EMCrit 372 – FoundStab Intubation SOP - April 5, 2024
Hey Dr Scott, I’m an AEMT who works 24 on 72 off, often pulling an extra shift in between as either a 24 or 12 hr overtime shift. Do you and your show guests have any tips on how to maintain energy level for studying since I’m also in a master program?
Most days I get off and barely have any energy to study after I get off shift.
Thanks,
Jerald Grissom
Thanks Scott, both my husband and I work 24 hour shifts, he actually has a 48/72 schedule at the fire department and I work 24 on/ 24 off as a flight nurse. Any advice to us EMS workers?
Would love to hear more about eating on night shifts- when to eat, should we fast, etc.
Don’t know if this helps, but when i was a registrar, and finished my last night shift in a block I’d walk home (35km from one hospital!), then have a nap and an early night. Really got me back into a day cycle. That morning melatonin seems to helpa lot. Luckily, consultants in Australia don’t do night shifts, so now i dont have to do nights, just on calls …
Hi Tonia, did you use melatonin to sleep during the day? I was concerned I’d mess with my natural melatonin and sleep cycle too much but have wondered about this. Thanks for your input.
I have struggled with 24s as a flight RN. I’m relieved to see that other people have needed to take this as seriously as I did. It was a factor that I just couldn’t manage well and wasnt discussed. Would truly love any advice on the life of 24s as well.
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EM night doc here-
How to optimize health while working permanent night shifts, not intermittent shifts? We frequently work a week on, week off schedules. Seem to get decent sleep/Works for family life and and also avoid previous erratic hours scheduling. All we hear is negatives regarding working only nights, but is this much worse from a health perspective than working AM/afternoons/PM shifts? Trying to sustain working nights optimize health.
Thanks,
Brian
Thoughts would be great for those like the ICU with an (unpredictable) chance of sleeping on shift, and fixed schedules (no casinos or anything).
I’ve worked full time nights now for going on 5 years. Having more and more trouble with switching after my run. I do 7 on 7 off. Any suggestions on eating exercising switching back to days. My commute is an hour and 10 minutes one way so that makes for a long 7 days. Also impacts how much I sleep and how well.
Dom Roca MD-PhD Pulm/Crit/Sleep boarded Stamford CT
Part of what makes you outstanding to listen to is that you are brilliant and have vast experience with the material you discuss.
I think it would have been more accurate and perhaps more helpful to have a sleep researcher and clinician speak about this topic with you. There are wonderful clinicians that run circadian clinics – their insight may have been more accurate. Thanks for all you do!
First off, amazing episode, thank you so much for putting this together Three groups of questions 1) A lot was talked about when to eat before a night shift, but what do you recommend as WHAT to eat before a night shift? Does high in protein vs. high in carb matter (Obviously different per person, but not sure if there was a general rule). For me, I wish I could FAST during a night shift, but I am always so hungry and have been unable to do this successfully. Maybe it is what I am eating beforehand that limits my… Read more »
Any thoughts on sleep aids for sleeping during the day prior to a shift rather then using a sleep aid to get back to a normal routine of sleeping at nights. I work 3 nights a week and need help getting some sleep prior to going in. Thanks for a great episode and topic, came at a perfect time for me!
This was fantastic! I learned so much and I’m doing so many things wrong. I’m 69 yo and still work mixed day and nights (12 hr shifts). I sleep okay during the day but still always feel groggy. My Achilles’ heel is the constant supply of junk food in the break room. I can tell it is the thing that negatively affects me the most.
Thoughts on Sleep “banking”?
Idea where you sleep super long times pre and post long durations of awake time. Like an example of 12-14h post nights and pre nights sleeping.
This use to help me prep and recover but is not working anymore as I age. Just curious if this is anything you came across with supporting evidence.
Thanks!
Jen
Hey Scott, Some experiences from my journey deep diving this for years. I have found certain things to be very helpful. I agree with your guest that a 1-2 hr nap prior to starting a night shift leads to feeling my best on night shift. A hot sauna can be tremendous for prepping for any sleep (excellent mortality benefit as well for frequent users) but ill use sauna before attempting some anchor sleep I am generally a terrible napper, but a focus on meditation and other body awareness and presence focused breathing such as Dr. Hubermans NSDR protocol (Non sleep… Read more »
why not invite a sleep medicine boarded Dr to the show? seems like an oversight O_O