Dr Carmel Harrington on SIDS & SUIDS, Triple Risk and Sleep for Health Introduction
Today we are visiting sleep again and unapologetically. So it’s a timely reminder for us all. And you know, I’m obviously very focused on sleep, both professionally and personally but I like to have a reminder on a regular basis as to just how important it is. And today’s guest knows a great deal about this subject.
Her name is Dr. Carmel Harrington. And Carmel is a researcher, a lecturer, an author, and an expert on sleep. Her wonderful book, A Complete Guide to a Good Night’s Sleep, has been adorning my waiting room for many years and it’s a wonderful book that I would recommend to you all.
She shares with us a personal story, which I think you will find very confronting and very interesting. I won’t spoil it for you. Look, I hope you enjoy this conversation I had with Dr. Carmel Harrington.
Dr Ron Ehrlich [00:00:08] Hello and welcome to Unstress. My name is Dr Ron Ehrlich. Before we start, I’d like to acknowledge the traditional owners of the land on which I am recording this podcast, the Gadigal people of the Eora Nation, and recognize their continuing connection to land waters and culture. I pay my respects to their elders of the past, present, and emerging.
Well, today we are visiting sleep again and unapologetically. So it’s a timely reminder for us all. And you know, I’m obviously very focused on sleep, both professionally and personally but I like to have a reminder on a regular basis as to just how important it is. And today’s guest knows a great deal about this subject.
Her name is Dr. Carmel Harrington. And Carmel is a researcher, a lecturer, an author, and an expert on sleep. Her wonderful book, A Complete Guide to a Good Night’s Sleep, has been adorning my waiting room for many years and it’s a wonderful book that I would recommend to you all.
She shares with us a personal story, which I think you will find very confronting and very interesting. I won’t spoil it for you. Look, I hope you enjoy this conversation I had with Dr. Carmel Harrington. Welcome to the show, Carmel.
Dr Carmel Harrington [00:01:33] Thanks for having me, Ron. It’s exciting to be here.
Dr Ron Ehrlich [00:01:35] Thank you. Listen, Carmel, your journey has been an incredible one, really. We’ve been just touching on it before we came on air but, you know, you’ve been a teacher, you’ve been a lawyer, you’ve done a Ph.D. in sleep. Can you just run us through how that happened?
Dr Carmel Harrington [00:01:51] Why.
Dr Ron Ehrlich [00:01:51] Why?
Dr Carmel Harrington’s Journey
Dr Carmel Harrington [00:01:53] Life is an interesting journey and it often takes directions that you never anticipated a nine-year-old. So when I first left school, as it was in those days, many years ago, one of the careers for women was teaching so closely toddled off to teaching and realized I didn’t really enjoy education so much. So I decided to then specialize in my actual initial love, which is biochemistry. And I was a biochemist for quite a number of years. And then the realization came that as a biochemist, you don’t make much money, especially in Australia.
The sciences aren’t paid very well at all. So I retrained as a lawyer and I actually specialized in that area in medical law, which was really interesting. So I was using it because it was clinical biochemistry I was doing. That was really interesting and I was quite happy in that.
Unfortunately, at that point, my son died. I had three children and I had a toddler that two and I had my son Alexander was about four and I had two-year-old twins or nearly two-year-old twins. And Damian died one night completely out of the blue, no reason whatsoever. And of course, it shatters you and it takes ages to pick up the pieces. But it never made sense to me how could a perfectly healthy toddler die one night.
No explanation, nothing at all. And I’d go and speak to whoever I could speak to and they just would say, it’s tragic. Go home and have more babies. Well, that irritated the scientist in me, incredibly. And so I started researching this area. And, you know, it was really tragic. We call it Sudden Infant Death Syndrome but these days because Damian was almost two, it would be referred to as sudden unexplained death in childhood.
Now, we think these deaths at this age of two is really, really rare. Well, it’s not it’s just not talked about very much. And so the more I researched this, the more I kept thinking we might not know what’s wrong with these children. It’s not obvious clearly. But there’s something fundamentally wrong to have such a catastrophic outcome, you know, healthy one minute and did the next.
So as a biochemist, I became very interested in what was happening, that most of these deaths do occur in sleep or that it’s presumed, they’re all presumed to occur in sleep but we’re not one hundred percent sure because no one is actually after death think. So the thing that looks out to you in your sleep is your autonomic nervous system, and that’s the nervous system that reacts, you know, arouses you.
Dr Carmel Harrington [00:04:43] Make sure that you breathe when you’re meant to, make sure that your heart rate increases when it’s meant to, etc., etc. So I actually gave up the law and decided to undertake study until my Ph.D. in the autonomic nervous system in infants. And so of course that was in sleep so I had to learn all about sleep, which was a huge learning curve.
In those days, we had these big machines that the pens would go all night and you’d have lot of paper this thick that you had to go through. And so you had to learn all about sleep. And then, of course, you had to understand the autonomic nervous system. So I did my Ph.D. and of course, the realities of life came back.
By that time, I was a single mom and I needed money to bring my children up and send them to school, like to educate them that schools. [00:05:41]I wanted them just to be expensive [1.2s] so I went back to law and at the same time I was doing clinical work, but mostly I studying law. And I was working again in sleep and I was getting lots of lectures around sleep, but adults sleep more than infants sleep and lots of people were so interested and it amazed me, I forgot that I didn’t really know much about sleep before I started.
And it amazes me how little people actually knew about sleep and how interested they were. And so one night after one of these lectures, and I was sort of traveling the world doing this sort of these talks and someone said to me, what book can I read about this? I said, well, there is no one book out there at the moment, but there’s lots of papers.
So I refer them to some academic journals. And of course, this person will want if you write the book. And that was the start of my public life. And since then, of course, I’ve written two books and I do a lot of work, both in the adult world of Slate, but also my research is still ongoing at the Children’s Hospital with me. And we’re looking at the biochemistry now of the autonomic nervous system. And so it’s going really well. It’s a long journey, but it’s exciting.
Dr Ron Ehrlich [00:06:54] Wow, wow, wow. I mean, this was how long ago did Damien died?
Dr Carmel Harrington [00:06:59] 30 years ago.
Dr Ron Ehrlich [00:07:00] 30 years ago. So this was and my kids are of the similar age. You know, this was something that we’re hearing a lot about and really, tell us a little bit about the condition as it was understood as it is understood now. How common is it? What’s the story about.
Sudden Unexpected Infant death (SUID)
Sudden Infant Death Syndrome (SIDS)
Dr Carmel Harrington [00:07:21] Look you’re right, Ron. Wasn’t it something we were all scared of at that time because there was very little ability to monitor children? You just hope against hope that it wouldn’t happen to you. At the time when Damien died, it was more common than it is now. And just after his death, I had this back-to-sleep campaign where babies weren’t being put on their tummy.
I think we got a decade before Damien was born, there was this push to put babies on their tummy and you sort of sleep on their tummy. That change because the incidence of sudden infant death was much higher in those babies that had been put to sleep in their last sleep on their tummy. So they did this back-to-sleep campaign. And there were babies are put to sleep on their back and recommended not to put on their stomach.
As a consequence, the rate of SIDS decreased dramatically, however, at the same time, we reorganize definitions so states now is startled. So there’s sudden infant death in infancy or SIDS, and sudden unexpected death in childhood. And there’s a very thorough crime scene investigation which it has to be. So as a consequence of that investigation and very strict guidelines on what can be called as SIDS. If a baby is found face down, then it’s not called the SIDS anymore. It’s called a Sudden Unexpected Death in Infancy or SUDI because they believe that this is an explanation for the death because the baby suffocated.
Now, as a consequence of that, the figures look better when you look just at SIDS compared to if you look at the umbrella of sudden, if you put everything under the umbrella of sudden unexpected death in infancy while the rate is much better, it’s still not we would like it to be so basically about three babies die every week in Australia.
Dr Ron Ehrlich [00:09:33] Wow.
Dr Carmel Harrington [00:09:34] So that’s every second day a family is going through the most unbelievable heartache that stays with them forever and it breaks up families. It does. It is really tragic and it’s very much out there. And our understanding of it has improved remarkably.
We know there’s particular risk factors for ease of understanding sudden infant death, there’s a model that we use in research called the triple risk model. And so one of the aspects is like all three things have to happen at one time. So we have to have a child at a particular age and maturity. So different things happen as children mature and the nervous system matures post-birth. So we have to have them in a particular vulnerable point of age.
We have to have a certain risk factor in evidence, so it could be that the baby is lying face down, it could be that they have sleep apnea, which we’ve talked about in the past, it could be that they’ve got an upper respiratory tract infection, so it’s making them vulnerable, but there also has to be a third component.
That has to be an underlying vulnerability that is inherent in the child. And at the moment, well, we know a lot about the maturation process, we know a lot about the risk factors, we know nothing about this third component, which is what is the inherent vulnerability that these children have that differentiates them from the rest of the population. And that’s what we are honing in on at the children’s hospital at the moment. I feel very confident about what we’re doing for the first time in 30 years, to be honest.
Dr Ron Ehrlich [00:11:24] Well, then let’s just keep that, because my initial question, the one that comes up in my head is what’s on the shortlist of possibilities with that last one? But let’s start with the age one. What is the age? I mean, is sudden unexplained infant death syndrome, does that occur at six weeks? At eight weeks? At 12? When does that kick in as a possibility and induce a diagnosis?
Dr Carmel Harrington [00:11:51] Well, by definition, an infant is less than 12 months. So sudden infant death can only occur in babies less than 12 months. Because that’s the infant period. However, infancy doesn’t stop until one month. Before that period you referred to it as a near night. So definition-wise, sudden infant death is only recorded in babies from four weeks of age to 12 months of age. If you stand outside of that and you’re older, then it’s called sudden unexpected death in childhood.
Dr Ron Ehrlich [00:12:28] Yes,.
Dr Carmel Harrington [00:12:29] So most death, sudden death can occur at any time in your life, at any time in your life, OK? So we’ve all heard of the adult that just didn’t wake up as well.
However, most of the cases, in fact, I think from memory, I’m not 100 percent sure. Eighty-five percent occur in the first 12 months of life, the next 10 percent occur in the first two years of life, and then the rest occur for the rest of their lives.
At any time, people are vulnerable but as you age, the likelihood or your vulnerability to sudden death decreases significantly, but indeed your greatest period of risk is in the first six months of within birth. So interestingly enough, within the first six months of birth, you would think a baby would be born with a fully mature autonomic system but they’re not.
There is growth and maturation of the autonomic system in that first six months. So it does leave a child most vulnerable in that period. I mean, other researchers you would talk to, would talk about other theories. But me and my team, we’re really focused on the autonomic nervous system.
Dr Ron Ehrlich [00:13:48] Neonatal reflexes is something that children born with and then as we mature as 12 to 18 months, two years, I think, by about two and a half to three, most of those, are they playing a role in this as well?
Dr Carmel Harrington [00:14:03] Well, a lot of people are looking at that as well, the reflexes. So for the first four weeks, we have quite amazing reflexes that are very protective and they start to diminish after the neonatal period. And so people are looking at what is that what effect the diminution of these reflexes are having on an arousal. Because basically one of the things that you can’t get away from is that a child that dies and must have faced a catastrophic event and has failed to respond to that catastrophic event.
I mean, that’s the basic fact that mostly, as I would often say to people I work with, people I counsel is if a baby is lying face down and becomes it starts to increase their carbon dioxide and decrease their oxygen, their arousal mechanisms should kick in and they can hit. Now, that’s a very basic movement that all children, all babies have. They can able to move their head or cry. They wake up. They don’t these children don’t arouse to this challenge.
Dr Ron Ehrlich [00:15:18] And then the second risk factor is the face down, the sleep. I mean, face down is such an interesting one, isn’t it? Because I think if I’m not mistaken, Dr. Spock may have played a little part in this because of his, you know, suggestion that line people on their stomach in case they regurgitated food. That was the rationale behind that. But do we know in sort of traditional cultures, I mean is this sudden death experienced in Hunter-Gatherer societies and traditional cultures?
Dr Carmel Harrington [00:15:56] Yes.
Dr Ron Ehrlich [00:15:57] The answer is yes?
Dr Carmel Harrington [00:15:59] Yes. Now, when I say yes, that has be little qualified because you can’t actually call sudden infant death unless it’s a full autopsy.
So in many, many parts of the world, they don’t do full autopsies for all sorts of reasons. It could be a developing country and their resources unavailable, For religious reasons people aren’t allowed to do autopsies. So when we have an international conference in this area, there’s a lot of acceptance and talk about babies that just died suddenly in the night or in their sleep, it’s not nice because it can happen any time, in the 24 hour period.
But you can’t call it SIDS because there’s been no autopsy done or not appropriate testing. And the guidelines these days, as I say, is much stricter than it was 30 years ago, because the idea behind this is to try to get absolutely true cases of SIDS so that they provide a good scientific model for us to try to work out.
So there’s rationale for all of these decisions, which is quite good, but, you know, sometimes the devil is in the details so while we make a really good decision on that basis, sometimes it doesn’t help on another side. But, yes, it’s a worldwide phenomenon. But one of the things that anyone listening to this should know is one of the biggest risk factors that we have is smoking.
Dr Ron Ehrlich [00:17:32] Of the parent.
Dr Carmel Harrington [00:17:33] Of the parent, of the mother, or indeed environmental cigarette. So the mother intaking the cigarette smoke during pregnancy and even post-pregnancy as well. So while only about 15 percent of moms smoke, SIDS babies, about 70 percent are born to smoking. And the environmental effects of cigarette smoking is a huge thing that we really could change.
Dr Ron Ehrlich [00:18:05] And the other thing you mentioned, sleep apnea in kids. And I know parents, you know adults are becoming more aware, they’re certainly aware of snoring either voluntarily or involuntarily, they’re aware of it. But the focus on obstructive sleep apnea as a serious issue for adults is something that’s gaining a lot of attention. But in children, I don’t ascribe that either, do they? What’s the kind of, what are we seeing in terms of incidence of that in children?
Sleep Apnea in kids
Dr Carmel Harrington [00:18:35] Two to four percent of children will have sleep apnea. We do mostly with infant sleep apnea and we put little babies on sleep. And it’s one in fact, that’s one of the things I did do is develop a mask for infants. So it was more comfortable for them to wear it.
Yeah. So obstructive sleep apnea in infants can be quite devastating, the effects of it. And often a child will present a failure to thrive, sometimes they have other learning difficulties, lots of presentations, and once we get this sleep under control, then we fix up their obstructive sleep apnea.
They start to make their milestones, they start to thrive because sleep is so important, as we’ve discussed in the past, not just for adults, but for children. And children, the effects of lack of sleep is more exacerbated because they can’t learn, they can’t grow, they don’t have good muscle development. So it’s so important to get children sleep on track.
Dr Ron Ehrlich [00:19:52] Hmm. And, of course, another risk factor, there was upper respiratory infections, which are common. And it’s interesting for me, Carmel. Because we know that many children, in fact, the vast majority of children are born with narrow upper airways than they should otherwise have, and that would predispose upper airway issues. So I can only imagine this in itself is a big issue.
Dr Carmel Harrington [00:20:21] Yes, but don’t forget, Ron, at the same time, they have to have this unknown underlying vulnerability. So the vast majority I’m talking almost every child has an upper respiratory tract infection. It’s absolutely fine.
Dr Ron Ehrlich [00:20:38] I don’t want everyone panicking.
Dr Carmel Harrington [00:20:40] That’s right. But the unusual child has a vulnerability that we don’t know about, and certainly, that’s the theory that we’re working on and I think most researchers in the world are looking for for this vulnerability.
What is it that we can what is it a marker we could possibly use to say, OK, this child is vulnerable like, you know, one thousand children are vulnerable. This one child is vulnerable and let’s just keep this child safe through this vulnerable maturation period.
So this is the holy grail of SIDS. And certainly by improving your risk factor that is not having a baby face down sleeping, that’s taking away one of the major risk factors. And as we’ve improved smoking rates off of parents, that of course, has brought down the rate of sudden infant death because it’s taken away one of the risk factors as well.
So the more we get rid of the risk factors, the better off everyone’s going to be. And that, of course, we’ve still got those children that will die because of this vulnerability.
Dr Ron Ehrlich [00:21:47] And when you talk about vulnerability, and I know it could get very technical if we got into the biochemistry of this, but are we talking about biochemical markers, genetic markers? What’s on the shortlist?
Dr Carmel Harrington [00:22:00] Well, there’s huge weird being done in the genetics space, as you could imagine. And some very interesting work going on there that I was speaking to someone the other day about. It was a conference that is not written up yet. But it’s really interesting, the genetic space I’m actually looking at, not surprisingly, the biochemistry, biochemical markers.
So these things would work together further down the track, I’m sure. And I don’t think sometimes that is 30 years ago now, it’s been such a long, long and protracted journey, that sometimes I feel like it’s not going to be that much longer until we unravel the mystery of this. And it will be I think, we will probably have a genetic marker and we might have a biochemical marker.
Dr Ron Ehrlich [00:22:52] Mm hmm. Wow. Fingers crossed. Because I can, yes. Well, the trauma of that experience. I can. Well, I mean, in our family, we had a stillborn between our two kids. So happening right at the last minute. At last, literally the last week. And, you know, it’s not what you expect to hope for and it is a trauma that stays with you and makes you appreciate the wonder of the children you have that you would otherwise take for granted.
Dr Carmel Harrington [00:23:23] I think that’s an absolute gift. You realize. Of course, you realize anyway, as soon as you have that beautiful baby, how much you just don’t love them. You adore them. But I certainly recognize even more just how wonderful and how lucky you are to have the children that you have and to have healthy children.
Well, the ones that you had. So I think while you would never, ever want this to happen to anyone, there are as time goes on, there’s certain gifts that are a consequence that you wouldn’t have if you weren’t you didn’t have to experience the trauma.
Dr Ron Ehrlich [00:24:01] And the other thing I would say is that if you’re fortunate enough to sail through every one of your pregnancies in children’s lives without any hiccups, that’s fine. But when it does happen to you, it’s surprising how many stories emerge that you haven’t heard before.
Dr Carmel Harrington [00:24:20] That’s right. And I have stopped judging anyone.
Dr Ron Ehrlich [00:24:26] Yes.
Dr Carmel Harrington [00:24:26] Because you don’t know the story beneath or behind. And you’re quite right, I don’t often share this story because it is too confronting for people oftentimes and they like to like things to be pretty and happy and all that sort of stuff. So you tend not to tell them the story.
But when you do, people, as you have done, have shared catastrophic stories that most of us have something in our life that we have to deal with on an ongoing basis, I believe. And it does make you a different person. I don’t think it makes you better but it makes you a different.
Dr Ron Ehrlich [00:25:08] Absolutely. Look, the subject of sleep in your book could consistently good night sleep is just a wonderful. That’s it, isn’t it? A consistently good night’s sleep.
Dr Ron Ehrlich [00:25:24] Complete Guide to a Good Night’s Sleep is wonderful book. I know I read it many years ago when we first spoke. Just for I mean, people are hearing this all the time, but I think it bears repeating why is sleep so important?
Dr Carmel Harrington [00:25:39] Yes, look at some. We live in an age that people want to shortcut everything. I don’t want to sleep that much because I’m not doing anything when I’m sleeping and it’s really boring and I’m not getting the rest of my life lived.
And unfortunately, there’s no shortcut when it comes to sleep and we sleep for about a third of our lives. So this is no evolutionary mistake. Evolution doesn’t make mistakes and we sleep, as adults, on average, about eight hours or we should for the simple reason that eight hours allows us to operate at an optimal in our wake for hours so people don’t. That wakefulness is basic to survival, OK? So we got to eat, we got to drink, we got to exercise, got to rid of waste products, all that sort of stuff when we are awake.
But when we sleep, we’re actually doing other vital functions that we actually can’t do when we are awake. So we get our body cleansing our brain, we’re bedding down information, we’re repairing and restoring our cardiovascular system, our respiratory system, we’re firing up our immune system.
All sorts of things that the body doesn’t have space to do when we’re awake is doing when we are asleep. And it is fundamental what these processes that occur in sleep are fundamental to our survival. And in fact, if you would, to deprive a group of rats of food and another group of rats of sleep, the group of rats deprived of sleep would die sooner than the group of rats decides to do.
So I don’t think I need to write them on anymore because that is very clear of the fundamental nature of sleep and what we do. So sleep underpins our physical good health in the short and the long term. It underpins our cognitive performance and it underpins our behavior as well. So a good ongoing behavior. So it underpins all of it.
Dr Ron Ehrlich [00:27:36] Yes. Music to our ears here come all to major focus, but it’s good to hear that. And that is beautifully put. One of the things that attracted my look, I was looking at your work and you mentioned men are from Mars, why women sleep differently to men, and what we can do about it. Can you talk to us a little bit about that?
Dr Carmel Harrington [00:27:58] Yes. Women actually have life stages, as we all know. We don’t give enough importance to this. So women go through puberty, but men do, of course, as well. Then they have the pregnancy so pre and post-natal and they then have menopause.
So at each of these last stages, it does present issues around sleep in a way it doesn’t for men. Now, just from men at puberty prior to puberty, men have an incidence of sleep apnea at the same level as the young boys and young girls have the same level of sleep apnea, same incidence.
However, post-puberty, boys vulnerability to sleep apnea increases because they get the elongation of the airway narrowing that airway. And of course, that’s why they have the descent of the airway, that’s why they have the deeper voice but it makes them more vulnerable to collapse because there all sorts of things happen here. So boys have that but girls have the introduction of estrogen and progesterone.
Now, progesterone is a soporific it actually makes you want to sleep more and you get more of that in the second half of the cycle. And what happens is in women from the age of puberty onwards and for the rest of life, actually need more sleep than men, but unlikely to get it. So on average, they need at least twenty to thirty minutes more than men. But some women would, of course, need more than that.
So as we age and we often get a partner, we might mimic their sleeping hours, but which means that you’re under-slept. But more than that, young girls in the second half of this cycle, fertile women in the second half of this cycle need much more sleep than the first half of this cycle but because we now go out to work and we’ve got the imperative of nine to five, most young women don’t get the sleep they need in the second half of this cycle that increase, and of course, when we think about lack of sleep, we know that it affects our behaviors, that we’ve become grumpy and irritable.
It affects our cognitive performance so we become foggy-headed and it makes us more likely to get colds and flu. So if you talk about premenstrual syndrome, you all of a sudden getting a lot of those characteristics right? Grumpy, irritable, foggy-headed, you know, and we’ve always put it down to hormones, you know. And yes, it is hormonal, but to my way of thinking and more and more people are recognizing this, we need to really educate young women about the need to increase its sleep in the second half of this cycle because they’ve got hormones that are actually making them sleepier and increasing their need for sleep.
And there’s a very good reason for this, because as fertile women, you might be incubating a baby and then the body’s going to protect you. So the body is really very harmonious and we need to listen to it more. So when women didn’t go out to work, they work in the home. The second half of the cycle, they could probably snatch an extra half hour hour sleep during the day. But they can’t do that now. And we’re not recognizing these biological differences. It’s great to think.
Dr Carmel Harrington [00:31:23] Yeah, I want to do this and I want to do that. Right. That’s fantastic. That’s what you want to do. And there should be no boundary with anything that a woman wants to do. But at the same time, we have to recognize the physiology is different and let’s play to our strengths.
If we want to put the best woman forward, then we need to be slept well as well. So I don’t think we recognize that. But of course, also, by the time postnatal is well, there’s all sorts of issues or prenatally, by the time a woman has a baby, the last trimester of pregnancy can be very difficult in terms of sleep. And so many of these women, by the time the baby is born, a sleep deprived and it sets them up, so imagine all that on.
And of course, by the time a woman is perimenopausal at that age, about 50 percent of women. So that’s wanting to be put to sleep issues.
Dr Ron Ehrlich [00:32:19] Mm hmm.
Dr Carmel Harrington [00:32:20] Yeah, men, and women are different.
Dr Ron Ehrlich [00:32:22] Yes. Boy, I mean, I often reflected on the third trimester, which physically, because of the size, the bulk difficult to get comfortable, but it’s kind of dismissed. So it’s getting used to having sleepless nights with you, your baby getting up and.
Dr Ron Ehrlich [00:32:39] Oh, no, no. Wow. Yeah. And you mentioned also that prepubescent boys and girls have the same level of obstructive sleep apnea. What is that? I mean, you mentioned infants has two to four percent have obstructive sleep. Is that the same statistic as we going to, you know, as we were approaching puberty?
Dr Carmel Harrington [00:33:02] No probably more around the two percent? And, of course, that can be influenced by the crowded upper airway, as you spoke about. It could also be influenced because now we have an obesity problem, you know, even in our children. Yes. And so that’s going to increase your vulnerability to obstructive sleep apnea. So, yeah, about two percent, I think.
Dr Ron Ehrlich [00:33:27] Now, another area that’s challenging from the sleep perspective is shiftwork.
Dr Carmel Harrington [00:33:31] Yes, absolutely.
Dr Ron Ehrlich [00:33:33] Talk to us a little bit about some of the challenges there with shift work.
Dr Carmel Harrington [00:33:38] But, of course, shift work, as we know on average, get at least one hour less than the general population. But it can be as many as three hours, one to three hours less because if you’re working through the night hours, you’re going against your internal biological clock.
So your melatonin is your master hormone. Melatonin is not only a master hormone, but it’s really important in the story of sleep and also in the setting up of your biological rhythms. So when we’re exposed to dim light or as the sun starts to fade more generally, our body, our brain starts to reduce melatonin. And about an hour and a half after we start to reduce melatonin, if we stay in the dark or the dim lighting, we’ll be ready to go to sleep.
Now, when we wake up in the morning and expose our body to bright light, there’s an off switch of melatonin at that point. Now it set off switching of melatonin that sets up the biological clock for the next 24 hours. That determines when you get hungry, when you got the greatest cardiovascular strength, when your blood pressure is highest and the lowest, it determines all sorts of things is lovely biological clock.
And our body loves nothing better than routine, right? And so what happens to a day worker is, OK, I go to bed at 10 o’clock, go to sleep, if we’re lucky, we get up at six, our biological clock is set at six o’clock and that is consistent day after day after day. And so everything runs like clockwork very harmoniously.
Now, compare that to the shift worker, one minute they’re exposing their eye to bright light at six o’clock, the next minute they’re trying to stay awake in bright light at three o’clock in the morning so the body doesn’t know when is my clock going to, you know, when is my body clock going to have a routine? So this actually makes people with shift work have all sorts of an increased vulnerability, all sorts of chronic illnesses, because, as I say, the body likes nothing better.
So shift workers are much more likely to have mental health issues, much more likely to have gastrointestinal issues, more susceptible to certain hormonal cancers. And the list goes on. So shiftwork is accounts for about 20 percent of our workers at the moment, and it’s not going to go away any time soon. So you think about all the health care workers, right?
Dr Ron Ehrlich [00:36:15] Yes. Yes.
Dr Carmel Harrington [00:36:16] And under the stress that they’ve been under the last year, it’s just incredible, the work they do, I don’t get recompensed enough for what they do, I don’t think our fabulous health care workers. So shift work is not going to go away any time soon so we need to educate shift workers on how to get the best, make the most of the time they have. And I don’t think, by and large, we do this well enough because it is a public health issue and we’re not dealing with it well enough.
Dr Ron Ehrlich [00:36:49] And what would you, well if you had to give a shift work, a few hints to say this will get you back on some sort of track because it’s going to be a compromise.
Dr Carmel Harrington [00:36:59] It is a compromise, so I’ll just take an example with someone who works nights, OK? So if you’re on night shift, you don’t try to do so. So often people work night shifts and during the day they’re expected to do things so they might have young children and the other partner is out working so they, I mean not shift workers meant to pick the kids up from school or make the breakfast or whatever.
A night shift worker can’t do that, when they’re on night shift that day is their sleep, it’s not time to do all this other stuff. So one of those things is actually having that adult conversation between the partners as to, OK, you’re on night shift so I can’t rely on you to do anything during the day because you meant to be sleeping. So that’s a huge issue.
I’ve spoken to many, many people about this they go, but I have to pick the kids up, no you don’t because you’re not really there. You’re meant to be. This is your two o’clock in the morning. So the other thing is, so if you’re working night shift, you actually have your largest meal prior to the night shift.
So if you’re starting work at let say, you’re a health care worker starting work at 10 o’clock at night, you’d probably have your dinner at eight o’clock, imagine meal at eight o’clock at night, then you’d have a light lunch in the middle of your shift and then you have a small amount of food when you get home. So that way, you’re right.
The worst thing you could do is have a large meal when you get home that’s just because your body is trying to digest. So you eat according to your daytime hours, unfortunately, but you don’t want to make it too late because that’s going to cause some other problems. Try to have a lot of shift workers because the day and everything’s all disrupted. They have processed foods.
It’s easy access to processed foods, but that has been shown to be really detrimental to sleep so Whole Foods are really important in the story of getting to sleep. And so if you’re on night duty, let’s say you starting work at ten o’clock, then if you come off shift at six o’clock or eight o’clock in the morning, then you sleep for most of that day but you might actually wake up at two o’clock in the afternoon or three o’clock could be harsh or could be anything that’s fine, get up then do something, but then try to have a sleep, a full sleep cycle prior to the start of your shift.
So when I say sleep cycle, that’s about ninety to a hundred and ten minutes sleep prior to the start of your shift. But make sure you give yourself enough time to wake up from sleep before you drop to work and on your way home from work, try to minimize your exposure to bright light.
Dr Ron Ehrlich [00:39:53] Including sunlight?
Dr Carmel Harrington [00:39:54] Not absolutely not glasses, but lots of people think I need the sunlight to wake me up to drive home. But if you’re feeling that tired, I do recommend having a 15-minute power nap or 20-minute power nap before you lay foot.
So people who have shift work in the environment, people who have employed by people, the employer should provide someone with these people can have a 15 to 20-minute nap before driving home.
This is especially important in remote areas where this sort of issues happening there because of a 20-minute power nap will just get you over the hump of tiredness, it won’t affect your ability before sleep when you get tired, but it will keep you alert enough to drive home safely.
Dr Ron Ehrlich [00:40:39] I mean, I just think there’s been something incredibly reassuring, hasn’t there, since the beginning of time that the sun has come up every day and the sun has gone down every day. And it’s played an important part in everybody’s life, but to take that out of the equation. Can we play around with melatonin there? Is melatonin supplementation have a place in this shift worker.
Dr Carmel Harrington [00:41:05] Yes, melatonin is really getting lots of attention these days. Unfortunately, people using melatonin for all sort of things. But there’s three situations where I think melatonin is good. Shift work is one of them. All right. And you would use it according to what’s going on with your shift.
So people have to take advice on when it’s best to take the melatonin if they work in shift. But yes, shift work, jet lag can work really well and for sight impaired people because I don’t get the sunlight that they need. And so that’s it. And so by giving melatonin to certain people, it helps them stay upper, they of course, can have one, but it doesn’t trying them a little bit better.
Dr Ron Ehrlich [00:41:58] Now, another issue that people face is insomnia we hear a lot about. And it’s a word that’s bandied around, you know, I’ve had a few bad night’s sleep, I’m suffering insomnia. How do we define insomnia in the first place? How do we know whether we really are suffering from insomnia? What is it? How do we know?
Dr Carmel Harrington [00:42:15] Insomnia has a clinical definition so it’s unable to initiate or maintain sleep with the result that you don’t get enough sleep and it has a daytime consequence, you might be fatigued all day or you might be getting headaches, so it has a daytime consequence, and it has lasted for more than six months. So that’s the clinical definition of insomnia.
However, we will all go through they might have acute insomnia, so something traumatic just happened to the stock market, for example, you know, and everyone’s losing their savings for the first couple of nights you’re not sleeping well. So that’s acute insomnia and it’s subsequent to a shock. And so, of course, you’re not going to be able to sleep because you’ve got adrenaline pumping around your body and this sort of short term insomnia where, for example, you might start a new job or a relationship break up or whatever, and for a couple of weeks you don’t sleep well. And most people go through that.
The real issue is the chronic insomnia, where people over a period of six months or more are really having a tough time. And one of the issues with chronic insomnia is that people get so desperate to sleep that they start to implement all sorts of unusual behaviors that they think might help them with this, that by the time they come to someone like me, you actually have to unravel all of those behaviors because they aren’t actually helpful but it’s one night it might work, it might not work.
And there’s a lot of these people actually don’t want to be on medication but if they go and see their GP, they are given medication. Now, in the short term, that’s great. Some people need sleep. And so if you need a prescription sleeping pill for a little bit, that’s OK. The trouble is, of course, people then start using them. They go back for another script, another script, and another script.
Dr Ron Ehrlich [00:44:16] What is short-term for you? How do you define short-term?
Dr Carmel Harrington [00:44:20] 10 to 14 days?
Dr Ron Ehrlich [00:44:22] Because many people have been on it for months or years.
Dr Carmel Harrington [00:44:24] Yeah, that’s right. The trouble is, of course, the efficacy is lost. The actual pharmaceutical benefit is lost at that stage. But that many people, as you say, are on it for months or years, but without any discussion about what’s going on with your sleep. Why do you keep needing these?
So indeed, the conversation should be had and doctors are getting better at this. I gave you a script a month ago, let’s say, why do you still need it? You know, what’s going wrong with your sleep? Do we need to look more forensically at what’s happening to allow you to get a natural sleep? Because prescription or most drugs will change the structure of sleep and not for the better.
Dr Ron Ehrlich [00:45:19] And I’m guessing that it’s interesting that you should say that because it often surprises me how often patients come in on anti-depressants or anti-anxiety. And no one has ever explored their sleep. And, you know, it’s the same kind of thing. What do you, what sort of interventions do you suggest for people who do suffer from insomnia, real insomnia?
Dr Carmel Harrington [00:45:44] Yeah. So what you know, often sometimes insomnia, There’s a couple of things. So insomnia can be for absolutely no reason whatsoever if we can’t find the cause, it’s primary insomnia. Now, in that case, it’s quite difficult to treat.
One of the things you’d like to look at is, OK, so you got primary insomnia so some people think they need eight or nine hours sleep at night or eight hours sleep at night. But their mom, the grandmother, and the grandfather they haven’t even set for five hours.
So, in fact, I have had a case where a person, actually, from genetic history, family history was a short sleeper and they were so convinced they needed seven hours, but in fact, by the time we were finished, she was quite happy doing the five or six hours in session, taking the stress out of the fact I’m not getting seven to eight because they were telling me I need seven to eight and I’m going to have all these consequences when in fact she was one of the rare few that didn’t notice much that it could be.
But secondary insomnia is it’s obviously secondary to some other issue. So it could be secondary to a sleep disorder. It could be secondary to anxiety. It could be secondary to sleep practices like behaviors. So that is much easier to treat. And so we unravel that story. We check all those things. And by and large, secondary insomnia is something that is more common than primary insomnia.
Dr Ron Ehrlich [00:47:19] Mm hmm. Yeah. Look, we’ve covered some ground here today, Carmel. I really enjoyed our talk and want to have links to your website where you’ve got those resources of your books and everything. I wondered if we might finish now. Just taking a step back from your role as a researcher, as an author, as a lecturer, and because we’re all on this health journey through life in this modern world, what do you think the biggest challenges are for us as individuals on the journey?
The Biggest Health Challenge
Dr Carmel Harrington [00:47:52] You know, I think maybe. Well, I did feel, sometimes I feel that people have lost the joy of lives. Yeah. And sometimes I look at people and they’re so busy trying to get ahead in this money-dominated world, the joy of life has sort of been taken away. And maybe that was highlighted a little bit last year when all of a sudden the world changed. And we were some of us were forced back into the home, back into what is really important here. And that was a bit of an eye-opener for some.
For others, of course, it was such a stressful period. They lost their income. They could have lost their homes. It really, really shocking. But I think one of the issues is that if we have the priority about life should be, problems and traumatic events which happen to all of us, there should be a level of joy and happiness in life. And if that’s missing, that then affects our health and our wellness and all those things.
I think really we need to come back to basics. What can I do to increase my level of contentment? It doesn’t have to be joyous, it doesn’t have to be happy, but my level of contentment. And with that comes all other things I think. So, well, we can concentrate on how we exercise, how we feed ourselves, and how we sleep, and maybe we have that journey via how content am I with what’s happening in my life?
Dr Ron Ehrlich [00:49:25] Well, that’s a great definition, Carmel, and thank you so much for joining us today. I really enjoyed it.
Dr Carmel Harrington [00:49:31] Thank you very much, Ron.
Dr Ron Ehrlich [00:49:34] Well, I’ve been looking forward to talking to Carmel for some time, and of course, sleep is, as any regular listeners to this podcast will know, is a theme that we have touched on before and we will touch on again. And I’m unapologetic about it, really, because we need constant reminders in our lives that sleep is without a doubt the most important part of the day.
Now I’ll have links to Carmel’s Sleep for Health website. She’s got a terrific book, The Complete Guide to a Good Night’s Sleep and The Sleep Diet, which are two wonderful books that, you know, well worth reading. And, of course, her story about her own experience with her two-year-old son who died from, well, SIDS or SIDS-like condition is a story that you can follow, also will have links to it, it’s called Damien’s Legacy, which is a story about the research that Carmel is doing at Westmead Hospital.
Quite sobering, really think that three children a week die of this sudden unexplained death syndrome. And yet funding for this is difficult to find. Just to put that in perspective. One woman a week dies from domestic violence, and this has gained a lot of attention, quite rightly so, and should be getting a lot of funding to deal with these issues of domestic violence. That’s one death a week. And with these three deaths a week,
I mean, this it’s an incredibly traumatic experience. That is Carmel said you just don’t get over. You know, the hole in your life may become smaller, but it’s always there and it does change your life forever.
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This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.