Jeffrey Durmer, MD, PhD
Dr. Durmer is a neurologist, systems neuroscientist and board-certified sleep medicine physician with particular expertise in technology-enabled sleep-health delivery systems.
He has coached professional athletes from the NFL’s Atlanta Falcons to the USA Olympic Weightlifting team on how to use sleep to enhance performance. He’s also worked extensively with high school and college athletes and was a competitive rower.
As one of the nation’s leading experts in applying the neuroscience of sleep and circadian rhythm biology to workplace fatigue and wellness programs, he has had the opportunity to work with many different industries and organizations to address the unique problems confronting these populations. His focus is to help people along their path of holistic well-being by ensuring they receive the best care that science can provide.
Moderator: Hello, everyone. I’m Nigel Ball with Nox Health, where I’m program manager for the SleepCharge program. I’d like to welcome Dr. Jeffrey Durmer, chief medical officer at Nox Health. He’s one of the nation’s leading experts in applying the neuroscience of sleep and circadian rhythm biology to athletes, fatigue management and health care programs. Dr. Durmer is with us today to talk about his role as the sleep and circadian performance physician — that’s a mouthful — with the U.S. Weightlifting team, part of this year’s U.S. Olympic team in Tokyo, Japan. Welcome Dr. Durmer.
Dr. Durmer: Thank you, Nigel. Thanks for having me.
Moderator: So what will you be doing with the team?
Dr. Durmer: I will be flying to Honolulu, Hawaii with the team on the 12th of July and spending the entire camp with them and the performance team for the Olympic Weightlifting team, while we help to adjust them towards the Tokyo time zone from wherever they are in the United States to Hawaii, and then from Hawaii to Tokyo. So I’ll be spending a lot of time ahead of that scheduling things and making sure that everybody’s schedules are circadian organized so that they can be 11 time zones from the East Coast of the United States, going west, towards Tokyo, in the right time zone to lift weights when they get there.
Moderator: And does that involve telling them when to go to bed, when to wake up?
Dr. Durmer: What I’m doing and what I have been doing for the last three years with the team is providing them with programming. So just like weightlifters and athletes of all kinds, program things like their eating and also their rest periods and their workouts into their day. This is really a new science in some ways for a lot of athletes. But it’s something we’ve been doing for a number of years, which is helping athletes, especially those who travel, get coordinated with the performance dates and times, so that their circadian rhythms for sleep and wake are adjusted and appropriate for their performances. The other thing we do, and program for, is the use of sleep itself as a training tool.
And one of the things that the team has been working on over the last three years is using sleep as a recovery component. And that allows them to perform again, physically, the next day. In a way that you or I may just kind of do weekend warrior stuff, they’re doing warrior stuff every day, especially at the Olympic level. So their rest is a serious part of their regime. And I program that for them.
So, days and weeks and months ahead of these events, I’m actually calculating their sleep needs, calculating how much excessive sleep debt they’re going to be put into from the different traveling issues they come up with, as well as the time zone changes. And then just the stress of those travel arrangements. I mean, flying to Tokyo is a big deal. And it takes a lot out of you just physically sitting for hours and hours and hours. So how do we compensate for that, for that change in their routine? They go to bed with a schedule that I gave them.
Moderator: Is this individualized for each athlete? Or is it a general plan?
Dr. Durmer: There’s a lot of folks that have specific sleep needs that are either in excess or less than the average. And that’s true for duration needs and quality you need. Some people have very good duration in their sleep times, but their quality is suffering. So it’s very much tailored, especially when we’re talking about the Olympic-level athletes. So we’re really tuning directly their sleep and wake to their individual needs, which includes their own circadian type. So I did a morningness-eveningness questionnaire with all of the athletes originally a few years ago, and we’re using that now to help predict their adjustment to new time zones, but also in terms of when they are most likely to perform well, in terms of their weightlifting itself.
Moderator: That’s fascinating. So you’ve been doing this quite a while? And how did it come about that you got into that line of endeavor?
Dr. Durmer: Well, it’s funny, I was an athlete myself so I was a rower on the U.S. team and competed to go to the Olympics, got injured, didn’t end up there, but ended up going into medicine instead. And since then, I’ve been very interested in helping athletes and getting them prepared and also coaching.
That’s probably about 10 years ago, and we’re starting to see literature around using things like sleep banking, some of the stuff that Dr. Mah did out in Stanford originally with basketball players and swimmers and runners, and looking at sleep banking as a potential, useful tool. And I started to apply that to my own athletics, my kids who were national level swimmers, they were in national programs. And they started to apply this to their swim teams. And all of a sudden, I started working a little bit with the U.S. Swim team. And then the weightlifting came from the CrossFit world where I was introduced to powerlifters and weightlifters, two different groups. Those are very different populations, by the way. And started to work with the weightlifters, the Olympic weightlifters. And they asked me to join them on their performance team about three years ago with their nutritionists and dietitians and medical staff and all of their performance folks.
Moderator: I know that you’ve worked with a variety of sports, you’ve just mentioned several of them and also NFL, I believe. Is there a difference in the sport and how much they can benefit from such a program? Or is it fairly even across the board?
Dr. Durmer: Yeah, it’s a really good question because the individualization of the sleep and circadian timing, it really depends on, first off, what your needs are. So if you look at some sports, like when I worked with the NFL football players in Atlanta, I worked with the Falcons for a number of years, their needs even within the team are significantly different. So you have running backs and quarterbacks and defensive backs who are running constantly. They have different metabolic needs than linemen who are running as well but who are undergoing almost like a physical weightlifting event every single time the ball’s hiked, so they have very different needs and metabolic output that really predict some of the impact that that has on your sleep needs. So working with each individual, we found that a number of the folks who are running constantly, their cardiovascular impact that that has on sleep actually is something that increases durations, the need for duration of sleep. Sprinters versus distance athletes have different metabolic needs, and metabolic needs tend to increase the drive for sleep. So if you use more metabolic equivalents, which is a way to equalize different sports and output, those metabolic equivalents can actually predict the number of hours you’ll need of sleep to recover.
And we can look at some sports like baseball and some racquet sports, not like tennis, but more more like badminton sports and ping pong sports, where there is not as much weight being lifted, and it’s occasional sprinting kinds of activities, their metabolic equivalents are lower than those that would be something like swimming or rowing or even weightlifting or boxing. So we can see those differences actually predicting their duration needs and, in particular, how much more sleep they’re going to need after an event. So it really is quite individualized, it’s something we don’t apply to a whole team, but we look at the individuals on the team and find what their needs are.
Moderator: So for the layman, what kind of difference are we talking about between bad sleep and good sleep in terms of performance? Can you give it a percentage, a difference between winning and losing? What is fitting?
Dr. Durmer: Yeah, well, it’s interesting, when you get to a certain high level of sport — we’re talking about elite level professionals and Olympians — just a small change, just a little bit more recovery can translate into like a half a second gain in a 50 or 100 meter swim. It could translate into a PR, a personal record, in a lift. And actually one of the small, little changes that we make to the timing of the sleep, as people go across time zones, also can predict significant outcomes. And that’s been shown in a number of studies, too, where different types of sports like NFL football players playing on the West Coast, who are from the East Coast, at night do much worse than the West Coast teams. And the West Coast teams even still have an advantage when they go to the East Coast, in comparison, because they’re in a delayed time zone, they’re used to going to bed later. Now, that’s true if it’s a night game. But if it’s a day game, and you bring the West Coast to the East Coast, the East Coast has a little bit of an advantage. So those are the sorts of things that we’re trying to level the playing field, when we’re talking about the small increments of benefit that you can get, that can translate into winning or losing at this level.
Moderator: So if my over-60s soccer team were to sleep a little better, we wouldn’t finish bottom of our league?
Dr. Durmer: You know, maybe, but also you wouldn’t maybe perhaps get as injured as well, because that’s another aspect of sleep and recovery, it actually helps to protect you from the onslaught of injury. And actually one of the things, this is not a data collection event that we did with the football teams, but one of the things that the staff, the physical therapy group and all of the folks that handle the players after the game, the director of of the medical teams, the thing they stated to me afterwards, when we had the first year of the program, was they’d never seen so little injury, and so little problem recovering from injuries in the weeks between games. So the thing they noticed most and the players noticed most from extending sleep and from treating sleep disorders within the population, which we also did, the big benefit was that they stayed healthy. And they recovered from injuries which they get every game in football in the professional leagues. Every game there’s an injury, that injury and how quickly you recover really changed in their minds.
Moderator: So as a scientist and clinician, have you learned anything, personally, from your experience with the teams that can translate back to everyday practice of medicine?
Dr. Durmer: Yeah, I think one of the things that translates back to everybody is that routine is a significant benefit for everyone. It’s something that if you look at the top level professionals or the top level of elite athletes, routine is built into their lifestyle. And that routine is something that not only they depend on for their physical attributes, and also their mental preparation, it’s also a part of what helps their sleep to become part of their routine. And that’s something that I coach all of them, all of the athletes I work with, I think all of us can benefit from that concept. That if we can retain the concept of routine, in terms of when we go to sleep, how we go to sleep, and then when we wake up and how we wake up and what we do on a day-to-day basis. Just like our eating is a habit, our sleeping is a habit and our waking is a habit.
Moderator: This has been fascinating. Thank you very much. We greatly appreciate your comments.
Dr. Durmer: Thank you, Nigel.