Hi there, everybody. Welcome to another episode of the CloudBase Mayhem. I've got a great show for you that's quite different than our typical stuff. Today, with my good friend, Bill Beninati. Bill lives down in Salt Lake City, so I drove down to visit him last week. The excuse was to get heli hoisted. He runs the heli search and rescue crews across Utah and runs all that. He's kind of the main medical doctor behind all that training and advice for all those crews. He has been my safety and medical director for the last three, well, since inception of the Global Rescue X Red Rocks, the hike and fly races that I run down in southern Utah.
Bill is just one of those guys that the planet is thankful to have around. He's an amazing human being. He's been in medicine this whole life. He was a doctor for the Air Force for a long time. He's lived in various different places around the world practicing medicine. He's currently an ER doctor, works in intensive care and specialties in a number of things. But the one we talk about mostly in this show is his background in pulmonary medicine. He's an expert in altitude sickness and all things related to getting tall, which is how... it relates to flying. He's recently also got into sailplanes. He's getting one delivered here any day from Slovenia.
And that's pretty exciting. We talk a little bit about that. But anyway, I drove down to do the heli hoist training at night with Bill. And then the next day I stayed at his place. The next day we sat down and had a really incredible conversation about things you, and we all need to know about when we go flying, especially when we go flying tall. There's been a lot of really amazing stuff going down and adventures going down in Pakistan and the Himalayas. So we start there and just talk about the physiology of hypoxia and chambers and decompression sickness. And he talks a little bit about... You all heard the sailplane show with Gordon Boettiger out in the Sierras flying wave.
If you fly sailplanes and get really tall, this one is especially important because he has some great advice on how you really need to approach that from how you... the correct way to use oxygen, the correct ways to breathe. He wanted me to point out that in the talk, he missed a couple of things that were important, namely, you need to be breathing oxygen before you get high. And you need to do that in a very specific way. You know, long, deep breaths rather than shallow, quick breaths. But we talk about another pilot friend of mine who was trying to combat hypoxia without oxygen just by breathing really deep breaths.
And you can tweak that and get totally sideways if you do that incorrectly as well. So we talk about all the physiology that goes into hypoxia, why it's so important to understand why it changes, can change pretty radically from day to day, depending on how hydrated you are and how sleep deprived you are and just where you are mentally. It can affect some people much, much lower. And a lot of that depends on how adjusted you are to altitude, how much time you've spent at altitude, where you live, if you live at sea level versus up higher. But the main takeaway is that if, you know, if you're heading off to go fly in the Himalayas in Pakistan, you will be, no matter what, operating at less capacity than you're used to.
So, you know, if you're Aaron Durogati or Antoine Girard and you're a beast, you know, you can go there and have a pretty safe trip. But if you're not those guys, you better give yourself quite a bit more margin in padding. Then we transition to sleep hygiene. He's a real expert in that as well. That term may be new to many of you, But pretty interesting stuff on just the importance of sleep, and what it does to you when you don't get good sleep, and how you can become a better sleeper and use gadgets like the Garmin watches and many others these days that can track sleep pretty accurately. So we talk about that. And then finally, we get into just something he's personally passionate about is just living longer, something we're hearing a lot about,
and fasting and all kinds of stuff you can do to slow aging potentially, but also just living better longer. And so health as it affects us when we age and what is aging and how we can, what we can do. We don't go real deep into this, but just some interesting stuff that he's been tracking and following. And certainly something we all probably think about as we get a little bit older. Those incredibly
incredibly giving with his time. He's an amazing human being, a very good friend, and he and I will be spending some time together here in a couple weeks after the Swiss PWC doing a little baby flying in Europe for all of his very generous support of the show. So look forward to doing that with him. And I'm glad to be able to bring you this talk with a very fine human being. Enjoy. You
have a lot of history together, you and I, and it's great to be sitting here in your office and in Salt Lake and spending some time with you. And it's always a treasure to be able to do these live. So thanks for your hospitality. And thanks for being on the show. We've been talking about doing this for many, many years. It's good to finally get there. Thanks, Gavin. It's a privilege to be here. So we're going to talk kind of three main subjects. You call it sleep hygiene. Maybe we'll get into the definition of that and what it means. We're going to talk about about hypoxia and oxygen, and your extensive background in studying altitude sickness and how O2 works and how our brains work when we're up high, and talk about health and longevity and what's going on in that space.
Many people will be familiar with fasting and cold and heat and the things that go into this and eating and nutrition. But you've got, again, a great background on that. But why don't we give some people some insight and some background? Your history is just beyond fascinating. It's amazing what you've accomplished in your life. And let's give people the resume version of what you've done and how you understand these topics so extensively.
OK, yeah, sounds good. So I am a physician with specialization in pulmonary medicine, critical care, sleep disorders and flight medicine. I had a long career in the Air Force, started as a 17 year old at the Air Force Academy, and if you string together that in medical school, I was in the Air Force for twenty nine years, so quite a bit of operational experience, you know, doing those things that I just described again in a in a clinical and operational setting. Now I am with a large non-profit health system here in Utah. It's called Intermountain Health. I am the chief medical officer of what is essentially our virtual hospital.
So it's a collection of capabilities that includes
our health programs, our medical transport programs. So air and ground. We operate about 60 aircraft for rescue and patient transport. We have a clinical command center, outreach, disaster preparedness. So that's my that's my work here. And of course, I still, you know, practice medicine. Great. And
you're a longtime avid pilot. And so that's been the is the interest of pulmonary, the pulmonary side of your background and the interest in hypoxia stuff. Has that been driven more by your time and in flying paragliders and soon to be a lot more time flying sailplanes?
Yeah, I guess I'd probably say both. Yeah, the two of them, the two of them definitely go together. Plus, you know, I went to college at 7200 feet. Would regularly travel as high as you can get in Colorado, 14000 feet. So I kind of developed a personal interest. I don't know. Maybe that's what drew me more towards pulmonary medicine. Interesting.
Let's talk about hypoxia. There's you know, this is something that we talk about quite a bit here in the Intermountain West, because when we fly, it's pretty easy to get really tall. And we can't go above Class A airspace unless you're in a sailplane. But still, you know, 17999 and about 5400 meters is an altitude where that definitely becomes a factor, both from just cold and impairment and feeling good. And so talk about basically what it is. You know, we're seeing we were just talking about before we started recording. We're seeing some amazing stuff in the last decade come out of Pakistan and what people have been doing there and obviously starting way before that.
But in terms of, you know, mountaineering and just people playing up tall, what is it and what does it do to us?
Yeah. So oxygen is critical to our biologic function, right? Like there are metabolism, sustained metabolism depends on oxygen. And that's our physical performance and our mental performance. The atmosphere is 21 % oxygen. And as you go up higher in altitude, the total barometric pressure goes down. And so what we term the partial pressure, the pressure of oxygen goes down. So you have less oxygen available for your metabolism. And we start to see physiologic effects as again, this is for a sea level dweller, not acclimatized. You start to see physiologic effects as low as 5000 feet of elevation,
primarily affecting your night vision. That would probably be the first thing that starts to get impaired. And as you go up from there, the effects become more and more pronounced up to the point of unconsciousness. And in aviation medicine, we use the term time of useful consciousness. So if you take somebody and expose them to altitude, how long are they able to function effectively? And when you get up into, you know, ranges that are easily reached in general aviation, you know, twenty three, twenty five thousand feet, then you can start to measure time of useful consciousness in minutes. You know, you know, you may still be awake and responsive, but you'll be confused and unable to operate an aircraft.
So one of the things that's true about hypoxia is the symptoms can be insidious. Right. A person may not know that they're developing this. And this has led to a number of serious aviation incidents. Many of you may have heard of the beloved golfer Payne Stewart. Right. And he died because the, you know, small jet aircraft he was in had a loss of cabin pressure that went unrecognized and everybody fell asleep and died a hypoxic death. And the airplane flew uncontrolled across the country until it crashed in the Dakotas. And it's just, you know, it's just a one little bit of a problem. because this is a type of car accident that happens with everybody on board. And there have been a number of other incidents. You know, when you look at
careful military and NTSB records, literally thousands of incidents. So one of the things that that I went through many times in the military is hypoxia training. And some of this is training you how to deal with the oxygen systems you'll use in flight, and some of this is to help you learn those symptoms. And we do that now, actually. Here at Intermountain, we have a hypobaric chamber, and we'll put lifelike crew members inside there, make them progressively hypoxic, and we'll have them do little simple neuropsych testing so they can see the extent to which they're impaired. And we have them specifically write down what symptoms they're feeling, so that if that were to occur while they're flying in an aircraft taking care of patients, they would recognize those symptoms themselves and say, "Hey, we need to check out if something happened in the aircraft," because it does.
These aircraft systems fail, and you get hypoxic. Why
didn't the crew in the Payne Stewart situation why didn't they wake up when it's when they started going lower when the plane started going down to crash? Yeah
They had, or probably had, already died at that point. Like, you know, the hypoxia can kill you there. What we know is that fighter jets were launched to intercept them, and their fighters flew close enough to look through the window and see them unresponsive, right? The canopies were, the cockpit windows were frosted over, but they could see through that these guys were there, not responding. radio calls and on the cockpit voice recorder they just stopped talking so probably at that point they'd had enough hypoxic exposure that they their time of useful consciousness turned into coma and potentially turned into death.
Wow, so a couple of just personal experiences, and I thought it maybe it'd be instrumental to have you kind of walk through what happens. The first time that I'm aware of hypoxia being a factor was late teens. I was down in Bolivia hiking in the Andes, and there was three of us, and as we got higher, we hadn't done much acclimatization. We were—we were not mountaineering, we weren't; it was nothing technical. We were just going for a hike, and it was day two, and three of us got what I would call hypoxia because we all got silly, but in different ways. I was kind of a goofball and just basically a cartoon character; the buddy I was with got really just mopey and sad and pissed and didn't like anything or anybody.
I don't remember, there was a girl with us too, I don't know, but it was—it was very interesting to me, especially in retrospect, to look at this and go, "Wow, that we had no idea what was going on." We were young and stupid, but it was interesting how it affected us differently.
Yep, absolutely right. That's the reason that we do this hypoxia training: for you to learn your own symptoms, how they affect you, and then part of the debrief, right, is what things did you observe in your other crew members? And that just gets you more attuned again in a hiking environment. So what, then you turn around and come back down again in an aviation environment? You know, that could be a really big deal flying around weather. And so, yeah, that's—that's literally part of what we're going after: is how do you not only recognize in yourself, but recognize that your crew members are behaving differently and then index that to hypoxemia.
The becoming stupid is an interesting one. The the second time, I really noticed it. Was on a big flight at home in Idaho. I was with flying with Nate Scales, who you know, and we were flying with oxygen, and we were, you know, pretty deep in Montana at this point. And I was a little bit ahead of him, and he called me on the radio, you know, "Where are you?" And at the time, I was pretty tall, somewhere 16 5 17 grand something, and I responded, and what I thought was intelligible English, and he said, "What? Say that again?" And I said, "Well, here I am at whatever I was." And he said, "Gavin, you sound like a four-year-old." And I thought, first I thought, "Oh, it's my visor.
My visor must be down, and it's messing up my microphone. The air is coming in in a weird way." And I went up to reach up to to open my visor, and it was already open, and then I went, "Uh-oh." And then I very painfully tried to go, "Hi, Nate. This is Gavin." And he said, "You sound like a moron, you know?" And then I realized, "Wow, I've been flying around for, I don't know how long, having no... I didn't... I... it struck me that suddenly. I thought, "Oh, I'm paragliding, you know?" I had just been looking around at the scenery, just kind of on autopilot, I guess, and Thankfully, in doing all of that, just wandering around in the sky, I got lower and realized, and then it, you know, started being able to think again a little bit more and realized, "Oh my, oh, two tanks out." You know, they've been a long flight, and I sucked it all down and just, I just thought I was completely fine.
I had no record, I had no idea that I was operating so impaired, I couldn't even speak, you know, absolutely
Classic, that's what happens. You get hypoxemia, that's low oxygen your blood hypoxia, um, and it causes impairment of your brain, and it can happen. There are individual susceptibility factors that can vary from day to day. One of the first things I, you know, the Air Force, alcohol and flying are really closely tied together, right? Pilots can drink like nobody I've seen, and so a lot of the early research looked at the interaction between alcohol or prior alcohol consumption in your susceptibility to hypoxemia, and so for example, if you had a, you know, a few more drinks the night before, that can affect you the next day.
Your general factors in your health, if you've got a little respiratory virus, there are a number of things that could make you more susceptible on any given day than normal, and again, that's why it's so important to recognize the symptoms you can in the systems that we have to fly with. If you're tuned to it, you can feel a little pulse of oxygen going into your nose, but at some point when you're flying around, you kind of stop paying attention to that, and so it's easy to not notice you're no longer getting oxygen because you've got wind in your face and all kinds of things, and so again, that's when it's important to recognize your own symptoms to say, "I may be getting hypoxia, or I may be getting hypoxia, or I may be getting in trouble." And of course, ideally, you would have recognized that in yourself before you became unable to speak intelligibly and then start to descend.
At that point, you
We're talking about before we started recording. I sat next to this guy down in a world cup in Brazil, and he had gone to, I believe it was Pakistan. I can't remember exactly where he, but somewhere high, and was really worried about this and was trying to acclimatize. They were
trying to acclimatize, and he was trying to
We're in an area that I guess didn't have oxygen available, or tricky to get it, whatever. Uh, talk about that acclimatization, vasoconstriction, dilation, yeah. Talk about what's going on and what you can do, or what you shouldn't do, to try to compensate. Because in this case, he talk about it was alcohol. What's it called?
Yeah, exactly. Alkalosis, so so humans can adapt to altitude up to a point, and it takes a matter of days, right? There's a lot of time to get there. Are the fit? There's a whole range of physiologic adaptations that can make you more effective utilizing the oxygen that you have available to you, that probably starts to break down at about 4,000 meters or so. Right above that thousand feet, yeah, it's really hard to, um, to fully adapt. And you know, if you look at, you know, human civilization, right? Nobody has settled above that. You can't have a sustained settlement because people just can't live that high. Um, and so these adaptations make you more effective.
One of the things that you adapt, one of the ways that you adapt, is that you breathe a little bit faster, and so that elevates the amount of oxygen in your blood. It also reduces the amount of carbon dioxide in your blood, and you can adapt to that reduced carbon dioxide, and you can adapt to that reduced carbon dioxide up to a point. But if it gets too low, right? You get what we term a respiratory alkalosis. So the, the pH level in your blood is low, and it's due to over-breathing. That respiratory alkalosis, or low CO2 level, constricts the blood vessels in your brain. We use that, by the way, clinically, if somebody's got an increased pressure in their brain and we're trying to race them to a neurosurgeon, we're trying to raise them to a neurosurgeon, we don't allow their carbon dioxide level to get high because that dilates the blood vessels in your brain.
We want to constrict it, right? But if you go, if you go too low, that constriction creates its own set of problems. And you know, you may see like kids fooling around and hyperventilating and passing out, right? That's what happens literally. You constrict the vessels in your brain so much that, um, you no longer have blood flow. And of course, the consequences of that are worse than the hypoxemia. And that's why we're so, so, yeah, the, what I guess I would say is probably don't try to outfox your own physiology. Um, and so in this individual was conscious of saying, "I think I'm getting hypoxic. I'm going to try breathe deeper and harder and deeper and harder." And he correctly analyzed that what had happened to him was that he caused this vasoconstriction from the low carbon dioxide.
So, but you can't, you can't breathe your way out of this. No, you can't breathe your way out of it because it causes other consequences. And there has been a lot of interesting research when you, the, the level of hypoxia that we tolerate varies from individual to individual, and there seems to be kind of a sweet spot, right? People who tolerate it too well and don't breathe enough with high altitude don't perform well. And when you look at the brains of people who have a really vigorous response when they come back from trips to altitude, they're more likely to have abnormalities in their brain caused by that vasoconstriction. There's probably a sweet spot in terms of how much your, your brain drives you to hyperventilate, um, to get your oxygen up, but not so much that you're causing, you know, vasoconstriction.
For any individual in, in that situation, it's good to have a normal breathing pattern, right? Deeper, slower breathing is more efficient and more effective way to, um, to breathe, and it makes better use of your oxygen supplies, by the way. But I wouldn't try to micromanage each breath, right? Then you can get into that kind of trouble. So just be conscious of, I'm not going to huff and puff, be conscious of trying to slow your breathing and then let your respiratory control take over. And then you can get into that kind of trouble, so just be conscious of that and take it from there. Why?
Is it that we as pilots can go to a place like the Caracorum and, you know, get there, you know, spend some time? You know, so you're, you're adjusting to the altitude a bit, and you're, you're changing your physiology a bit. But then you're able to do what in mountaineering would just kill you. You, you can, you can launch at 2500 meters and fly to 7500 meters, boat around for a while, get a little silly, probably hypoxia if you're not using O2, and but then come down, yeah.
So, you to do that, your skill level has to be greatly in excess of the skill level that's required to do that flying. And there's no question, even this has been very carefully studied in, um, both in an aviation setting, right, doing what we call neuropsychological testing in the chamber. You know what we do for my little course is, um, pretty basic stuff, but this has been done in a very careful, structured way. Even well-adapted people, when you get to the kind of altitudes you're talking about, you're clearly impaired. Um, there's no adaptation that's going to make you overcome that. And so, for the people who do the kind of things you're talking about, they showed up with a lot more capacity than they needed to make that flight.
And so, if you're as, as it is with so many things in life, if you're pushing yourself on hypoxia, you probably better not be pushing yourself on your skill level too, because then you're going to get into trouble. And so, again, the pilots who do this are very highly experienced, highly skilled pilots that are not near their limit of what they can accomplish. So, what you're
Saying, really, is you can't take if you're a 300k FAI pilot in the Alps, you can't just map that on to doing the same thing in Pakistan. You've got to have a lot more margin. Would that be a good way to do? Yep, exactly right.
Yep, your physiologic has to be a lot higher because you unavoidably are impaired. You may think you're not impaired; you're impaired at that level, and it's been nailed down, yeah.
So the, but a person who, you know, my friend Ben Abruzzo, who you know, who spends a lot of time in Santa Fe, working at the ski resort, and he lives at, I think, just shy of 13,000 feet, five or six days out of the, out of the, uh, week, and all winter he's better prepared for the winter, and he's better prepared for the winter, and he's better prepared in a sense, physiologically, to fly at higher altitudes than somebody who's living at sea level. Yep.
Absolutely right. There, all of these adaptations that occur in your body, you grow more red blood cells, you have more oxygen carrying capacity, your physiology adapts to you hyperventilating slightly at all times. You're there, are changes in your blood that allow you to unload oxygen in your tissues more effectively, right? He has had all those changes, and he's been those adaptations, and that's going to allow him to go higher, longer than if somebody just came up from sea level. So those, no question, those adaptations help a lot, but at, you know, you know six, seven, eight thousand meters, those adaptations are, are overwhelmed, and then you're relying on either you're bringing oxygen with you, or you've got skill that's well in excess of what the task calls for, because you're, you will be impaired.
We
Did a podcast to you? You reached out as soon as you listened to it, which was immediately, uh, Gordon Bodiger, who's been doing these amazing sailplane record flights out in the Sierras, flying in wave, and you know, very frequently, cruising around for hours. I mean, in that case, 17 hours using night vision goggles and stuff. You haven't heard that show? You got it's amazing, but he, you immediately reached out and said, "Hey, if you go with him because I've hopefully got"
a chance to do that in the future. I'm going to be able to do that in the future. I've got
An open invite to go out with Gordon and go flying. Here's what you got to do. Yes, and there was a story in there about his buddy that stole an airplane, so talk about that.
Yes, yeah. So, this is decompression sickness, right? For people who are scuba divers, understand the concept of decompression sickness well. Um, what happens is, you know, the the atmosphere is about 78 percent nitrogen. That nitrogen is dissolved in your tissues; it's dissolved in your blood. As you go up in altitude and the pressure comes goes down, that nitrogen comes out of solution, and it can come out of solution in your tissues and form little micro bubbles. And those micro bubbles cause a disease called decompression sickness, again well understood by scuba divers because when you're down at depth, you dissolve a lot more nitrogen and it comes up very readily.
But it absolutely can happen in flying, too, probably. Um, depending on susceptibility factors, as low as 18,000 feet, you can start to get, um, decompression sickness. It's pretty uncommon below about 25,000 feet; above that, it definitely occurs. And so, again, paragliders in general would not likely be flying at those kind of elevations unless they're doing something special. But sailplane pilots, absolutely. You can get clearance from the FAA to go that high, and you are at risk of decompression sickness, and it's a big deal. So, the story he told, one of his friends had had an episode of decompression sickness that, um, disqualified him from becoming a Navy pilot.
And so he decided he was going to be a Navy pilot anyway, so he stole an aircraft. What an incredible story! But the point is that decompression sickness happens, and, um, it's just like what you would experience diving, right? You get the bends or joint aches, you can get, um, skin changes. It's like Crawling, burning, itching sensation. You can get a rash, and you can even get, you know, neurologic symptoms. The prevention for that is pre-breathing oxygen, and if you saw the Top Gun: Maverick movie, right? There's a scene before his flight where Maverick is on a tight, sealed oxygen mask, running on a treadmill, right? So, if you just pre-breathe oxygen, um, over the course of about 30 minutes, you will start to clear a lot of the nitrogen out of your body because every time you exhale, nitrogen leaves, and every time you inhale, you're bringing in pure oxygen.
And so, out of your pulmonary and blood compartments, you can clear a lot of the oxygen, and for short exposures to altitude, that will carry you through, you know what is short individual variability, but maybe You know, 20 30 minute altitude exposure, you're probably going to be safe from getting depression sickness for longer exposures, like you have flying those kind of aircraft. That's not enough, and so you have to do special efforts to clear nitrogen from the other compartments. So, what I said is to tilt the odds in your favor if you're going to go into one of these kind of wave flights. Not only do you have to prevent hypoxia by taking oxygen, you want to clear as much nitrogen from your body as possible beforehand, um, and that's breathing on as closely sealed a mask as you can get pure oxygen before you even start to ascend, um.
When you do this in the military, for example, when we did this, you know, you, you, a single break in the system, you've got to restart your clock, right? And so, you know, for example, if we're disconnecting our mask and reconnecting it, you hold your breath at full inhalation, disconnect, reconnect, and start breathing again, because any nitrogen you get in, and then you have to start the process over again. And what happens if you don't? Yeah, then you increase your risk for decompression sickness, and just like in scuba diving, right? You know, two divers diving the same profile, one of them gets bent and the other doesn't. There are individual susceptibility factors, not an issue for you, but the more fat a person has on their body, the more susceptible they are.
Alcohol, our old friend, alcohol enters the picture again, you know, um. Alcohol increases your susceptibility to decompression sickness, um. Physical exertion, while you're in that environment, increases your susceptibility. So, yeah, it's just about trying to dial down the risk by getting as much nitrogen out of your body as possible if you're going to be up at those kind of altitudes. And then, by the way, if you develop those symptoms, then I would get help, right? Go to a, a recompression chamber. And that was one of the things we dealt with in the Air Force; if pilots reported those kind of symptoms, then we just dove them, um. And so, any clinical hyperbaric facility or the Divers Alert Network, right?
Um, you know, again, it's tuned for scuba divers, but it's the same physiology, right? They know where you can find a Divers Alert Network and get you to a, um, a chamber where they can recompress you
I had an interesting, uh...
Recent experience with the decompression chamber after a surgery; I had a shoulder surgery in 20. I was getting ready, I think, for the 2017 X-Ops and blew out my shoulder mountain biking, I don't know, eight months before. And so it was a pretty major surgery, and the the surgeon said, "Listen, we got to do everything we possibly can, uh, to get this thing to heal. Uh, so I want you to do 10 sessions, yes, compression chamber, because shoulders don't have a lot of blood flow. Yeah, and we need a lot, we need you to get healed so you can do the race." And so, talk about that. Yeah.
Absolutely. So, we use the term hyperbaric oxygen. That the reason, by the way, that our health system has a chamber is not to do high altitude training and research, to do treatments like that you describe. And so there are a lot of effects to that. One of them, the primary reason that we do hyperbaric oxygen treatments, are to accelerate wound healing in a situation that you describe. Often, people who have diabetes or vascular disease, for example, um, get a ulcer on their foot that can lead to amputations. And so you can accelerate the healing of those wounds by getting your oxygen levels to extreme. We use it for carbon monoxide poisoning.
This has been in our area; this has been a really bad winter and we've had a lot of people who have had hyperbaric oxygen treatments. And so we use it for, um, mass carbon monoxide events, and we'll like crowd entire families in, in our chambers, uh, to recompress them. Um, so there's a lot of good clinical utility. The, the doctor who leads our program, a brilliant researcher, was a former SEAL medical officer during a Navy career and is a prolific researcher. Had the foresight to have these when we got our chamber; they've got big metal dogs that extend from the around the door to help when you put it pressure on there to keep the door from blowing out, right? Well, he ordered our chamber with a set of dogs on the inside and a set of dogs on the outside, so that when we suck air out of the chamber and the door wants to blow in, it's held in place.
And so that's why we have a hypobaric chamber, but it's the same chamber, right? Um, you know, you basically fill, you fill it with air. We have small glass tubes that we fill with pure oxygen for an individual or, for example, a parent and a baby. If a family and we'll put them in a tube full of oxygen, it's not efficient to fill these big multi-place chambers, so we just, you know, pressurize the air and then have you breathe oxygen through a tight-fitting face mask when
These guys are going off to Pakistan and doing these big flights, or mountaineers are spending a ton of time and either using oxygen or not using oxygen. I'm thinking specifically, I mean, when I was in college, I went and saw—I can't remember his name now—but a really, very, very famous mountaineer who had spent a lot of time above 6,000, and he in his presentation, there were just these huge, just nothing, yeah, just he would just blank out, yeah, 30 seconds, 45 seconds, and then just click right back in and keep talking. And you know, I don't know if that was age or something else, but it was, uh, it was interesting to watch somebody who'd spent so much time in the death zone, yeah.
Are we, no matter what, are we doing damage so
In that context, it even—even in that context, the um, data is not clear, right? There have been a number of studies that show um, both neurophysiologic impairment and um, using MRIs, you know, changes in your brain structure. In general, a problem with those studies is they don't have a lot of information about what's going on in your brain, so they don't have a lot of, you know, careful pre-post. A few of them have done careful assessments before an altitude exposure and after, and in general, there seem to be changes. Most of the changes are gone by a year. Um, there may be some permanent changes, um, but that's a little different. To put that in perspective, a number of people who've had those kind of exposures go on in life and have amazing careers in academics, you know?
They're at one point. The um, the physician who, as far as I could tell, it had the most exposure to that kind of altitude was an academic hand surgeon, a microvascular surgeon, right? So, one of the most easily measurable changes in people who've recovered from that—that stubborn changes that doesn't go away over time—is fine motor control, right? And but this guy had superb fine motor control because he was a microvascular surgeon, you know? Um, despite his altitude. So, I to put it in perspective, probably most people are going to be fine, you know? Like, you know, the people who were had the most exposure without oxygen are going to have some impairment in an aviation setting.
The answer is probably not at all. I know Will Gab was on your show and he told the story about him getting hypoxemic on a flight and someone told him, "Well, you probably lost, you know, 10 points off your IQ or something like that." And I don't know, that that's valid. I think that maybe they were pulling his leg, whoever told him that. But um, as far as we can put together from chamber studies in an aviation context, those relatively brief exposures clearly impair your neurologic function. When you're hypoxic, when you return, that impairment last for a matter of minutes or hours. But, but the idea that you're going to have permanent impairment from that, unless it was a profound exposure that you were unconscious, is, is vanishingly small.
So I wouldn't worry if one of us is up flying at high altitude and we get a little stupid and come down again; I would anticipate we're going to have a full recovery of our brain. Let's
Talk about sleep. You gave a great talk last year to our challenge participants in the X Red Rocks, and you call it sleep hygiene, which I got quite fascinated with after my 2015 race, because you're—you're got—you go 12 days in that race and you get very little sleep. And I really thought that I kind of had the sleep locked because of all my years sailing; you don't sleep a lot on a boat, and it was just fascinating to go through. I—I talked to an expert down in Australia and—and worked with him, not extensively, but he—he gave me some guidelines that I still use to this day and—and
and and i
So again, a bullet point on sleep: why is it important, especially to us as, as pilots? What does it do in terms of impairment when you don't get good sleep? You know a lot about sleep, yeah? Mostly, yeah.
Absolutely, so um, again, sleep impairs you, and there's no escaping from that. And that physiology has been nailed down over and over again in careful studies in the lab. If you are impaired with sleep, your neuropsychological function, mood, your ability to learn new information, all of that goes down. You do not want to operate sleep-deprived, and there have been a number of major disasters in society that have been linked to sleep and fatigue impairing somebody that was operating a nuclear power plant, operating an aircraft, right? It's a really big deal, and you don't want to play around with that. Um, and so you want to approach that in a well-rested state.
That term, sleep hygiene, was actually coined by Peter Howry, right? A great sleep scientist, and I had the privilege that Dr. Howry was my program director, and he's the person who taught me um, sleep disorders and sleep physiology. And there's a big faculty, but he was like, he was my primary, um, my primary mentor. And the idea is, there are things in your day-to-day life that affect your sleep and wakefulness and your ability to function. Now, I rather than just give a laundry list, what I like, I use the term, be your own sleep scientist, right? I like people to have a, a basic working understanding of the mechanisms that affect their sleep so that they can make their own decisions about that.
And briefly, one of the factors that drives sleep and wakefulness, um, you know, we call it process S, or a sleep homeostat. Homeostat is a term from physiology that means our ability to normalize some, some physiologic function or bring it back to a baseline. So there is a chemical in our bodies and our brains called adenosine, and the longer you're awake, the more adenosine builds up, and the higher more adenosine you have in your brain, the more likely you are to fall asleep, right? And so as it is, adenosine comes up, you become progressively impaired. There are things, and then when you sleep, the adenosine level goes down again, right? So that's our process S.
So if you're in an environment where your process S is high because you're late in your wake period and you have to perform, things that we can do to dial that down would include taking a nap, right? And we use the term strategic naps, right? If you nap for too long, it's going to take too much sleep and you're, your process S away, then you're not going to be able to fall asleep that night. So napping too late in the day and, um, and napping excessively will, um, will cause that problem for you. Now, for our pilots who are flying emergency medical evacuation, we tend not to focus on the idea of strategic napping because they could have a very long day, and we just say, just fall asleep and get your process S as low as you can if you have the opportunity to sleep.
You're not going to be able to sleep when you wake up from a nap, you can have something called sleep inertia, right? That's the sense of that kind of fogginess, um, that you have on awakening. And, um, the answer to sleep inertia is that you probably take some kind of countermeasures, again, just some physical activity, um, uh, you know, splashing cold water on your face, brushing your teeth, things like that can kind of help accelerate you through that. So process S napping dials it down to improve your performance, and then you're going to have a very long day and you're going to have a very, and the other thing widely used in society is caffeine, and caffeine directly counter, counteracts adenosine in your brain. So if you need to perform, we all know that taking caffeine will help.
Again, double-edged sword, just like napping too much or too late in your wake period interferes with your sleep, caffeine can too. And in general, probably better not to have caffeine after noon. Some people have a little bit less caffeine and they're going to have a little bit less caffeine after noon susceptibility, and they could push it, but I hear people all the time say, oh, I can take caffeine late in the day and I'm going to sleep fine. They're not sleeping fine if you measure their sleep physiology, and this has been nailed down, the quality of their sleep is very poor because the caffeine that's on board
So, I know you're a big fan of the thing on our wrist. We both got a Garmin. How do you use it? Uh, how do you suggest people use it? Why is that a nice thing to be checking out?
yeah so
there are
A lot of brands that do this, there is a what we use years ago in sleep was something called an actigraph, which uses accelerometers to measure movement in whatever part of your body you put it on. Wrist is most convenient, um, and the amount of activity that you have, um, correlates to sleep and wakefulness, and you get a pretty good idea if somebody's awake or asleep. Well, accelerate to the current day, not only do these devices have accelerometers, but also can measure our heart rate, and they can even infer information about our breathing. And so the algorithms have become more and more refined to the point that they give a decent estimate, not just whether you're awake or asleep, but literally what stage of sleep you're in.
And, um, I have found over experience, given my, you know, thousands and thousands of sleep, formal sleep studies, I've read in the probably thousand or so actigraph tracings I've read, and I've read a lot of them, and I've read, um, I believe that this device is a very reasonable representation of my sleep quality when I fell asleep, how good my sleep is. And so, for example, I'll find if I go back and look at the last week, the the times I accidentally had caffeine too late, wasn't thinking about it, you'll see that, for example, my deep sleep was greatly reduced. Or if there's a special event, alcohol, by the way, is something else that interferes with your sleep. If there's a special event, a wedding anniversary, and have wine at dinner, I can measure the effect on my, on my sleep quality, right?
Which is why if I'm going to have alcohol, I'd rather do it in early in the day, you know, like in the afternoon, something like that, you know, grilling and having a beer or something like that. Get alcohol too close to your bedtime, and people think alcohol makes them helps their sleep and makes them fall asleep; it's terrible. The net effect of alcohol and sleep is terrible. So again, on night when sleep is important, push that away. This is great news. I, I love a day drunk. Yeah, exactly right, exactly, yeah. Or like I told the participants in this, it's a reason to getting goal early, have your goal beers at three o'clock in the afternoon. Boy, they taste really good. And then let that alcohol metabolize out of your body so that, uh, doesn't interfere with your sleep.
So I when
I look at my sleep profile, you know, when I just check it out on Garmin, it's directly, directly related to a scotch eight versus a non-scotch at eight exactly. I don't sleep well at all if I have a glass of wine after dinner or something, or anything, it just plummets, yeah.
And sometimes, you know, that the social event is more important, and you're just going to take a bad night of sleep. Sometimes, what you're doing the next day, your function is more important, and the the value is not there. So anyway, so that's process s, this sleep homeostat, um, the you can imagine that if you fell asleep very quickly, the adenosine goes down and there's a tendency for you to wake back up again. So we have a competing process that we call process c, or a circadian process, right? And, um, that is part of our brain physiology that controls rhythms, circadian around a day rhythms that occur around a 24-hour cycle, and, um, that has a potent effect on your sleep, right?
It's directly tied, for example, to shift work and jet lag, and if you want to have high quality sleep, it's important to pay attention to your, um, your circadian process. The main thing that affects our circadian process is light, right? It's like a, um, imagine if you had a set screw in your brain, it's like taking a screwdriver into that, turning that knob, that you know that that adjustment knob in your brain Light at the right and wrong time of day can make a big difference, and one of the things in our society with electric lights, we're surrounded by light late in the evening, and that has the effect of slowing our clock down. So, for example, if the clock on the wall says it's 10 p.m., which should be your bedtime, right?
Let's say that's, you know, uh, you know, an ideal sleeper, and the sleep doctor's, you know, idea of a perfect person is someone who goes to bed at 10 o'clock, takes about 20 minutes to fall asleep, and then wakes up at 6 a.m. or so without an alarm clock, feeling totally refreshed. So, if you're on that cycle, adjust the numbers based on your own personal life. If the clock on the wall says it's 10 p.m., but you've been staring at screens and had a lot of light, that's going to slow down the clock in your brain, and the clock in your brain says, "No, it's not 8 p.m., it's good to go, right?" And then on the other side of the, you know, the night, the clock on the wall says it's six, it's time to get up; the clock in your brain says, "No, it's only four, you should still be sleeping." And so the light messes with your circadian rhythm.
On the other hand, light in the morning has the opposite effect; it speeds up. And one of the things that we recommend is in that first hour to hour and a half after your natural wake time is that you get a really bright exposure, like out Side now, do not burn your eyes looking at the sun, right? If the light hurts your eyes and it's too much, what I—what I say is, go out on a sunny day and look at the horizon, um, away from the sun, right? Don't look at the sun, look at the—look up at the sky on a bright sunny day, and even if it's cloudy, right? And I've—I met it's easy to measure now in these days of having, um, these amazing smart
faces, you can. And I showed this in the talk for the challenge race, even on what looks like a cloudy day outside, the—the amount of light you're exposed to is much more than what you'd have inside. So yeah, in that early morning, whether it's, you know, really bright indoor light or natural outdoor light, that is a circadian anchor that helps keep you—that helps keep you entrained and make your circadian process do what you want to do, which is to give you sustained wakefulness and you're supposed to be awake, and sustained sleep when you're supposed to be asleep. So don't do things—part of the sleep hygiene is don't—things, do things that mess with your circadian physiology. tell
me about these people who say, "Nah, I don't need as much sleep, I'm fine." Yeah,
It's almost certainly not true. We use the term short sleeper, and there are many people who claim to be short sleepers, but when you put them in the laboratory and you find out that they're not short sleepers at all, right? That they have, you know, they're chronically sleep deprived, and when you put them in a lab, you'll see that they have tremendous amount of rebound sleep and in a research setting, and this has been researched, people, um, you know, their neuropsychologic function improves when they get recovery sleep. So there are a few genetic, genetically predisposed short sleepers, but it's far less common than people think, and but you're hitting on a very important point that chronic partial sleep deprivation, one of the effects that it has, is people think they're okay if you take one night of bad sleep, you're a good sleeper, and you have one really late pulling all night or something like that, the next day you know that you're impaired, right?
Compare that to the end of a work week where you're constantly shorting yourself, you're getting five or six hours a night every night because you've got something big going on at work and you're trying to catch up whatever at the end of that week, you're going to be short of sleep, and you're going to be short of sleep. You're thinking, "Hey, I feel pretty good, I'm doing okay," but if you do, you know, neuropsychological testing, you're deeply impaired, and if you go to bed in the lab, you're going to have like wall to wall slow wave rebound sleep, um, and and that's an insidious problem that you just need to understand your physiology, that chronic partial sleep loss is as bad as total sleep loss, and you got to find the time to take a nap or get a good night's sleep or use a countermeasure like caffeine to get your alertness back.
I
Think Chrigel is someone who really understands this, because he's been pushing as long as I've known him with the race. He's been pushing the organization to add sleep, because he just, he feels that it's just a recipe for disaster in the race when you go 12 days on limited sleep. So when I at which they this last race, they, they kind of did; they allowed you to adjust your, your rest schedule, and they added a half an hour. So he's made some, some gains there. But just to put it in perspective, when I spent some time with this, this gentleman in Australia who was like you, who really understood sleep, and I basically said, first he said, "What do you, what are you doing? And what, what do we have to adjust for?" And I explained the race, and he said, "Okay, what you have to do then is bank sleep." Yes, and, and that was, that was something I'd never heard of before.
And he made me feel quite good about it, because he said, "You know, I, when he, when he explained what it was, which you'll talk about, you know, before the race, just sleep as much as you possibly can." I said, "Well, I'm not a very good sleeper, I'm not going to be able to do that." And he said, "No, it doesn't matter, just lay down." Yes, absolutely, just, just relax, just relax as much as you can in the couple weeks before the race, just whenever you get a second, lay down. Yeah, yeah.
No, there's good science behind that. It's most used for shift work, and so, for example, this week, um, I worked all night taking care of ICU patients all night on Monday night, so I had a good night of sleep on Sunday night, but I made myself take a nap Monday afternoon to kind of bank up sleep for my night shift, and it really helped keep my performance going through sunrise when someone else took took over for my patients. So, there is good science behind banking sleep, and the other thing, in a related vein, is sleep extension for athletes, and there's also very good science that, um, that athletic performance, right, which is a combination of physical and mental performance, um, is enhanced by extending your, extending your sleep time.
And so, during a race, yeah, absolutely, you should look for every opportunity you can. You know, again, before a race, like you talked about, it can be hard because when we are traveling, it people are notoriously short-changed on sleep when you're getting ready for a trip and you're trying to arrange things in your life and what do I pack and all that other kind of stuff. And so, before an event, it's really a time to buckle down on your discipline in your life so that you don't let that get the better of you, so that instead of showing up sleep deprived, you show up having banked sleep. So, um, you know, you just have to start planning maybe days in advance so that you're not cutting yourself short sleep.
health longevity that you've got some, uh, again, this is something that you're—is this isn't your particular expertise, but you know a lot about it. You know, there's a lot of talk, uh, you know, especially on podcasts where people have too much time that they don't—they want to live forever. Yeah, they want to live 150 years. Yeah, talk, talk about this movement, uh, and what, but what we can do to live better, longer. Yeah,
Yeah, good. I think, um, I certainly don't want to live forever, right? You know, it's, you know, I, I've got my time on the planet, and when my time is done, I want to, you know, it's time for me to move on and let other people have their time on the planet, right? And, but the time that I have, I want to be able to function and keep paragliding and, you know, doing the other things that I love. And so we would use the term health span, right? To have your function be as good as it can, close, close to the end. And so there has been an explosion of research in this, high-quality research, right? A couple of recent Nobel Prizes that have been awarded have gone to scientists that have worked out the underlying, you know, molecular biologic mechanisms behind this.
And so if you pay attention to this literature, you'll hear the term hallmarks of aging. What changes happen in our body with aging? And it turns out that much of that stuff is not only preventable. To a to some degree, but but even reversible, and people have come up with different ways of measuring someone's biologic age and have shown that if you, you know, adhere to some of these relatively simple practices, that you can reverse some of that stuff. There are, there are a lot of experts on this. The person that I listen to the most is David Sinclair; he's Australian, he's a professor of molecular genetics at Harvard University, and he's done a lot of this work.
But there are many people. Walter Longo is a professor at USC. There are a number of people who have worked, who have worked in this area, and honestly, much of the benefit comes down to just doing simple things, right? Like, you know, eat less food. That already starts to make changes in your body that promote health span. Eat whole food, right? Not eating processed food, but eating whole food, right? You hear about, um, the nutritionists say, you know, your plate should be colorful, right? When you go through the, um, grocery store in the vegetable produce aisle, get brightly colored stuff. Well, it turns out that what makes those vegetables brightly colored—and they're not like that until right before you harvest them—they sense changes in their environment that stress them, so they make chemicals to counteract that stress.
And those chemicals, when you ingest them, do the same thing for you, right? So there's a whole list of biological compounds that are in those brightly colored foods that they did to protect themselves, that protect you, right? So nutrition, simple things with nutrition make a big difference. Um, moving your body, right? Um, you know, getting up and doing physical exercise. Being sedentary is bad. Sitting is bad, right? If you go to my office at work, you'll see standing height desks, right? Like, you know, the more time you spend sitting, when you exercise, some of it should be really high intensity exercise, and that promotes physiologic healing mechanisms. Sleep, we don't know that stressing yourself on sleep helps at all.
So, to our best of our knowledge today, sleep deprivation probably doesn't trigger any; it's probably just bad for you. So, so maybe stress yourself on physical exercise. I wouldn't stress yourself on sleep; just get good quality sleep as much as you can. Um, heat and cold exposure. The data, the science on this is a little bit mixed at this point, but there is certainly a signal that deliberate heat exposure, like sauna use, um, can help promote some of these mechanisms, and it's a little muddier with cold exposure, but deliberate cold exposure probably does, you know, as well. So again, the kind of things that a person living an adventurous life can do is to take a little bit of sleep and take a little bit of sleep. Those are the kind of things that end up promoting your health span, right?
Like, sometimes you're out in, you're physically fatigued because you're pushing yourself, you're too hot, you're too cold. All of those things make a difference. Now, beyond that, there are people who get a little bit deeper into it, and there are some more like supplements or things like that. There is a growing science behind some of those things that will promote that, but I would say the answer is not to think that you're going to take a pill that's going to fix this. The answer is for you to live a healthy life, and if on top of that you may get some additional benefit from supplements, but I'd be very careful. There's a lot of people out there that are willing to sell you expensive powders and potions that may not be very well, very well evidence-based, and you're going to get the most bang for your buck just, you know, doing the kind of basic things that I mentioned.
the talk about intermittent fasting in that space
Yeah, good. So, um, one of the things there is pretty good evidence that, um, a number of benefits, you know, of intermittent fasting—probably not necessarily for weight loss, right? I wouldn't promote that as a weight loss mechanism. In fact, I don't even like the term intermittent fasting because that makes it sound as if you're depriving yourself of something. A better way to term it, I think, is time-restricted eating, and the idea that you're getting the same nutrients and the same quantity of nutrients, but in a shorter time period. And one of the things that that does, by the way, if you get into about, you know, 18 hours or so, the primary fuel that your body is using are ketones, right?
Your body makes ketones, and those ketones have a number of beneficial effects, to include on your brain, by the way. And ketones
Are one of the things that seem to promote brain recovery mechanisms. Now, this scientist at UCLA, he's dual-appointed in Milan, in in Los and Los Angeles, has taken that to an even stronger degree and studied the effects, starting with like single cells up through, you know, simple organisms and mammals, and now human data, what will become a seminal paper just recently published on this, taking this up to five days. And if you, um, it's very hard to fast for five days, and there are a lot of injurious effects on that. So he is, he and his lab have come up with a nutrient mix that you can take that does not counter effect, any counteract any of the fasting mechanisms that you're doing, but has some fuel in your body so that you can continue to function.
So he calls it a fasting mimicking diet in, and he's got pretty solid evidence now that that fasting mimicking diet helps control and even reverse some of these factors that are chipping away at your health span. So again, there are a number of things, if what you want, you know, um, is to continue to function at a high level in our beautiful planet late in life, do some of these simple things that I mentioned. And again, that fasting mimicking diet is an intermittent or time-restricted eating on a regular basis, um, and and maybe occasionally throwing in one of these fasting mimicking diets are things that could take you to an even higher level in your health span.
I
have friends who are really into... I've just lost the word that, uh, not necessarily fasting, but cleanses, cleanse. What are your views on cleanses? Yeah,
I certainly know a lot less about the fasting mimicking diet than I do about the fasting mimicking diet, but I do know a lot less about the science behind cleanses the in general. In our world, it's hard not to be exposed to chemicals that have adverse effects on your body, you know? Here locally, right in the Salt Lake, northern Utah, big ski area, right? People wax their skis. Well, it turns out they figured out in the water supply around our ski towns, the flora wax use the term "forever chemicals"—chemicals that are adverse to your health that don't break down easily. The water supply has these forever chemicals in them, right? Yeah, P-fast, right?
And so, and it's coming from these fluoro ski waxes that people use that ends up in the water table and end up, you know, filtering down through there. So when I think about cleanse, I think about, you know, a conscious effort to get yourself away from that and allow your biologic mechanisms to clear as much of that stuff out of your body as possible. Now, some of these are fat soluble, and so the more fat or adipose tissue you have on your body, the more this stuff is going to accumulate, and so, you know, again, one more reason to not have as much adipose tissue because you can't accumulate so many of these chemicals. That's about as much as I could say about it. I don't know the I Mean cleanse, probably means a lot of different things to different people, but stay away from these chemicals as much as you can.
You know, microplastics and nanoplastics are a big thing, probably. These ubiquitous water bottles, maybe you're not a good idea. Maybe get a metal or ceramic bottle and just refill it from your tap. You know, not only is it better for the planet, but it's probably better from you, so yeah, just a few simple things in life to help limit your exposure to the chemicals, and this gets back to you in a food, right? Eating whole food, probably organic. Food, there's been some effort to prove that organic food is somehow safer or healthier. The biggest thing that I focus on are, you know, pesticides. And so I love blueberries, for example, and there's good evidence that blueberries are loaded with pesticides.
So I don't try to eat everything that I use organic, but you better believe that grapes and blueberries that I have are organic, because they're not organic. They're not organic; they're really susceptible to having pesticides that I don't want to have in my body, whereas other things are far less susceptible to that. And then I'll just eat whatever, um. Consumer Reports, by the way, this last issue had a really nice rundown of which foods are most—which produce is the most susceptible to that—which I use to help me understand which ones I really need to get organic or not, Bill.
Fantastic stuff. We've covered some great ground there. As always, I really appreciate you and what you've done in this community, and our flying community, and just the world community, just keeping people healthier and alive. And, uh, thanks for all your work. I know the the the COVID thing too was brutal for all of you in the medical space, so thanks for thanks for all you do. Yep.
Thanks, thanks for what you do. Um, I've often felt like people like, like you, push the limits of free flight in such a way that you've opened up room for the rest of us, right? You guys develop tech. and training and push the limits of gear, so that those of us who are like weekend pilots can do a lot more with this sport. And so, thanks to you and thanks to the high-end athletes that are pushing our sport that make the recreation better for the rest of us, thanks.
if you
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