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 Beninotti. 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 probably like I don't know I don't know I don't know I don't know I don't pretty tall somewhere 16 5 17 grand or 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
were 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 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're trying to raise 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 your self 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 it with you fill it with air we don't we have small glass tubes that we fill with air and we fill it with air and we fill it with air and we fill it 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
my sleep i'm like oh my god i'm so sleepy i'm so sleepy i'm so sleepy i'm so sleepy
check it out on garmin it's directly directly related to a scotch at 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 not eating processed food not eating processed food not eating processed food 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 you um push the limits of free flight in science and in medicine and in medicine and in medicine and in medicine and in medicine and in such a way that you've opened up room for the rest of us right you guys develop techniques 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
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