15. Building Capacity: Laura McGladrey on Stress, Resilience, and Long-Term Performance

Hosts: Dr. Teddy Bross & Dr. Roger Matthews

Episode Summary: This episode features Laura McGladrey, PMHNP discussing stress injury, resilience, and the importance of building capacity across the lifespan for athletes, first responders, and other high performers. Drawing from her experience in emergency medicine, wilderness medicine, humanitarian work, and behavioral health, Laura describes how cumulative stress can eventually overwhelm a person’s capacity to respond, much like a physical overuse injury. She introduces the stress continuum - from green to yellow, orange, and red - as a framework for recognizing early changes in capacity before stress develops into significant injury or burnout. The conversation emphasizes deliberately building a reservoir of capacity through sleep, nutrition, movement, relationships, creativity, joy, and consistent restorative rituals. Laura also introduces the concept of an Injury Action Plan, a proactive strategy for maintaining identity, connection, and purpose when an injury temporarily removes the activities and communities that normally provide resilience. Ultimately, the episode argues that with awareness, preparation, and community, athletes and high performers can adapt to changing capacity and continue pursuing meaningful, vital lives across the entire lifespan.

14. Weathering the Elements: Sun, Storms & Safety

Hosts: Dr. Teddy Bross & Dr. Roger Matthews

Episode Summary:

In Episode 14, Roger and Teddy explore how to stay safe while enjoying the outdoors, focusing on two major environmental risks: sun exposure and lightning. They discuss practical sunscreen choices, UV exposure and skin cancer prevention, as well as Colorado’s lightning patterns and strategies for avoiding dangerous exposure in the mountains. The conversation also covers what to do when caught in a lightning storm and, critically, how to respond if someone is struck - including reverse triage, CPR, rescue breathing, and the importance of medical evaluation afterward. The central message throughout is simple: prevention, preparation, and basic wilderness medical knowledge can save lives.

Corrections:

1. "Coronal paralysis" = keraunoparalysis. Transient, self-limited limb paralysis (with pallor, pulselessness, sensory loss) after a lightning strike.
2. "No benefit above SPF 50". FDA discourages label claims above SPF 50 because incremental UVB blockage is tiny (SPF 30 ≈97%, SPF 50 ≈98%, SPF 100 ≈99%). It is clinically marginal for most people, not zero.
3. "SCC comes only from chronic exposure; sunburns drive only melanoma/BCC" . Recent cohort and meta-analytic data link painful/blistering sunburns (childhood and lifetime) to SCC as well, so the clean split no longer holds.
4. Product/filter naming. The new U.S. filter is bemotrizinol (BEMT), marketed internationally for >20 years, most established under the trade name Tinosorb S (Parsol Shield is a separate brand designation). FDA issued a proposed GRASE order (up to 6%) in late 2025.

13. Western States as a Run Doctor Dad

Hosts: Dr. Teddy Bross & Dr. Roger Matthews

Episode Summary:

Teddy and Roger discuss Teddy’s 2026 Western States 100 experience, focusing on race preparation, crew logistics, fueling, managing fatigue and nausea, and the crucial support of family, friends, and pacers. Ultimately, Teddy reflects on the value of doing hard things and maintaining gratitude through difficult moments.

12. First Responder Medicine: Treating the Occupational Athlete

Hosts: Dr. Teddy Bross & Dr. Roger Matthews

Episode Summary:

In this episode, Dr. Roger Matthews and Dr. Teddy Bross explore the unique health challenges faced by firefighters, law enforcement officers, EMS professionals, search-and-rescue personnel, military members, and other frontline responders. Drawing on both clinical experience and firsthand service, they discuss why first responders should be viewed as “occupational athletes” whose jobs demand peak physical and mental performance under extreme conditions. Topics include musculoskeletal injuries, cardiovascular risk, shift work, sleep disruption, occupational exposures, PTSD, stress injury, alcohol misuse, resilience, and the importance of timely, personalized medical care. This conversation highlights practical strategies to help first responders stay healthy, recover from injury, and sustain long careers in service to their communities.

Anxiety Unpacked: From Survival Response to Regaining Control

Hosts: Dr. Teddy Bross & Dr. Roger Matthews

Episode Summary:

In Episode 11, Dr. Roger Matthews and Dr. Teddy Bross explore anxiety as both a universal human experience and a clinically significant disorder, explaining how normal, adaptive stress responses can become disruptive when the brain’s threat system—driven by the amygdala and sympathetic nervous system—overrides higher-order executive function; they emphasize that while up to a third of people develop an anxiety disorder, everyone experiences anxiety, and the key difference lies in loss of control and impaired daily function. The conversation blends physiology with practical application, highlighting how acute anxiety can be managed through simple, practiced techniques like slow breathing (especially prolonged exhalation), muscle relaxation, visualization, posture changes, and sensory cues (such as scent, sound, or touch) that help “create space” and re-engage rational thinking, while also stressing that these tools require consistent practice outside of high-stress moments to be effective. They discuss recognizing early warning signs, using self-awareness scales, and reframing perception to prevent escalation, while also acknowledging broader contributors like modern overstimulation, health anxiety, and feelings of powerlessness. For chronic or severe anxiety, they underscore the importance of professional support—particularly cognitive behavioral therapy—and note that medical causes should be considered. Ultimately, the episode frames anxiety management as a daily practice of building resilience through both mental skills and controlled exposure to low-stakes stressors, empowering individuals to respond more effectively when real challenges arise.

Key Evidence-Based Clarifications:

• Prevalence of Anxiety Disorders: The episode cites ~34% lifetime prevalence; most large U.S. datasets support ~28–30% lifetime prevalence, with variation depending on definitions and methodology.
• Neurobiology Oversimplification: The “amygdala vs. frontal lobe” and “reptilian brain” explanations are simplified models. Anxiety involves distributed brain networks (amygdala, prefrontal cortex, hippocampus, insula), not a single pathway or hierarchy.
• Autonomic Nervous System Framing: The idea of a simple sympathetic vs. parasympathetic “balance” is an oversimplification; real-world regulation is dynamic and context-dependent, not a binary switch.
• Technique Effectiveness (Breathing, Sensory Tools): Strategies like breathing exercises and sensory anchoring are helpful adjuncts, but not standalone treatments for anxiety disorders and have variable individual response.

Plantar Fasciopathy

Hosts: Dr. Teddy Bross & Dr. Roger Matthews

Episode Summary:

In this episode of Highpoints, Dr. Roger Matthews and Dr. Teddy Bross discuss plantar heel pain, now more accurately termed plantar fasciopathy, and explain why the older term “plantar fasciitis” is misleading. They review the key anatomy and biomechanics of the plantar fascia, including its role in supporting the foot arch and the windlass mechanism that tensions the tissue during toe-off.

Classic symptoms such as sharp first-step morning pain, worsening with load, and partial improvement with activity are emphasized, along with common risk factors like increased running volume, prolonged standing on hard surfaces, and limited ankle dorsiflexion. Diagnosis is primarily clinical, supported by ultrasound measurement of fascia thickening, while heel spurs on X-ray are noted to be poorly correlated with pain.

Treatment is centered on progressive loading through stretching and strengthening of the plantar fascia and surrounding musculature, load management, and gait modification, with adjuncts such as orthotics for temporary relief. For persistent cases, shockwave therapy and platelet-rich plasma injections are discussed as evidence-supported options, while corticosteroid injections are used more cautiously due to rupture risk. Surgery is reserved for refractory cases.

Overall, the episode emphasizes that successful recovery depends on consistent, active rehabilitation rather than passive treatments, with most patients improving over time when appropriately managed.

Corrections and Clarifications:

1. Heel spur correlation — overstated as "no correlation": "heel spurs do not reliably predict or cause plantar heel pain" rather than stating there is zero correlation.

2. Steroid injection "lifespan" described as "about three months": The Cochrane review found that corticosteroid injection benefits over placebo were present only up to 1 month, with no significant difference after 1–6 months.

Fixing Bedtime, Overnight Wakeups, and Sleepy Solutions (Sleep Part 4)

Hosts: Dr. Teddy Bross & Dr. Roger Matthews

Episode Summary:

In this episode of Highpoints, we conclude our series on sleep by focusing on practical strategies for common sleep challenges. We discuss difficulty falling asleep (sleep latency), the role of sleep hygiene and bedtime routines, and how modern habits like late-night screen exposure can interfere with the body’s natural sleep signals. The conversation also explores overnight awakenings, including how stress, illness, environmental factors, and evening habits such as late fluid intake can disrupt sleep.

The episode also touches on situations where staying awake is unavoidable—such as shift work, endurance events, or emergency response—and we review practical ways to maintain alertness safely during sleep deprivation. Throughout the discussion, we emphasize consistent sleep schedules, light exposure, environmental control, and behavioral strategies that help promote healthier sleep patterns.

Published Corrections and Clarifications

To ensure scientific accuracy, the following clarifications are provided:

1. Aquamation terminology: Aquamation, also known as alkaline hydrolysis, a water-based alternative to traditional cremation.

2. Causes of difficulty falling asleep: We suggest sleep latency problems are primarily due to mindset or an overactive brain. While behavioral factors are common, difficulty falling asleep can also result from circadian rhythm disorders, medication effects, stimulant use, anxiety or mood disorders, and medical sleep conditions. Work with your physician to fully explore these concerns if hygiene solutions are not helpful.

3. Nocturia and prostate size: We reference fluid intake as a major cause of nighttime urination. While evening fluid consumption can contribute, benign prostatic hyperplasia and other medical conditions remain common causes of nocturia, particularly in older adults.

4. REM sleep characterization: We describe the brain as “quite awake” during REM sleep. REM sleep does involve wake-like brain activity, but sensory processing and muscle activity are physiologically suppressed during this stage.

5. Anecdotal use of a battery to maintain alertness is referenced, this is not recommended. Although there is a low likelihood of serious harm, there are situations where this could be damaging or more concerning.

When You Snooze, You Win (Sleep Part 3)

Hosts: Dr. Teddy Bross & Dr. Roger Matthews

Episode Summary:

In this episode, we explore the critical role of sleep in physical performance, recovery, and overall health. From hormone regulation and tissue repair to mental resilience and cognitive function, sleep is a cornerstone of wellness that’s often underestimated. We discuss practical strategies for improving sleep quality, building healthy routines, and preparing for big events.

About Highpoint Direct Care:

This podcast is supported by Highpoint Direct Care in Golden, Colorado.

We’re Dr. Roger Matthews and Dr. Teddy Bross - physicians with decades of experience in movement, mountains, search and rescue, ultrarunning, and performance-focused medicine.

As a membership-based clinic, we give you unlimited visits, same-day care, and direct access to your physician - without insurance middlemen - so you get care that truly reflects your goals: strong bodies, resilient systems, and performance that lasts.

If you want healthcare built for athletes, mountaineers, first responders, and lifelong movers, check out highpointdirectcare.com.

Key Points:

• Sleep drives recovery: deep sleep supports protein and collagen synthesis, tendon and muscle repair, and hormone regulation.
• Cognitive benefits: REM sleep aids emotional regulation, decision-making, and mental resilience—key for athletes and everyday performance.
• Sleep extension strategies: gradual 10–15 minute bedtime shifts, consistent routines, and controlled sensory environments optimize sleep quality.
• Pre-event sleep: “sleep banking” or adding extra sleep in the days leading up to an event can improve performance.
• Travel and time zones: plan for 1 full night per time zone eastward, ½ night westward; consider tools like the Time Shifter app.
• Long-term benefits: sufficient sleep supports immune function, injury prevention, and cognitive longevity.

Claims Requiring Clarification (because we can get carried away, and admit it):

• NCAA sleep recommendations: There is no official NCAA guideline of 10–12 hours. Expert consensus: 7–9 hours for adults, with elite athletes possibly needing more; sleep needs should be individualized.
• Elite athletes: The “9-hour target” is not universal. Athletes often need more sleep than general recommendations, but exact amounts vary per individual.
• Time zone adjustment: Eastward travel does disrupt sleep more than westward. The “full night per time zone east, half night west” is a rough guideline, not a precise rule.
• One night of sleep loss: Even a single night of complete deprivation can impair performance (aerobic capacity, strength, power). Effects are smaller than multiple nights but not absent.
• Night-before competition sleep: The claim that poor sleep the night before an event is less problematic than two nights before is generally supported, though the evidence is mixed.

Sleep, Wearables, and Sleep Hygiene (Part 2)

Hosts: Teddy & Roger

Episode Focus: Understanding wearable technology and sleep questionnaires, caffeine and alcohol effects on sleep, methods to improve your sleep through sleep hygiene practices.

In Episode 7 of Highpoints, Dr. Roger and Dr. Teddy continue their deep dive into sleep, focusing on consumer wearables, sleep tracking accuracy, validated sleep questionnaires, and practical sleep hygiene strategies. The conversation emphasizes balancing objective data with subjective experience, avoiding over-reliance on consumer technology, and building sustainable routines that support sleep quality, health, and athletic performance.

• Consumer wearables (Oura, Whoop, Apple Watch, phone apps) are reasonably accurate at detecting sleep vs. wake, but poorly reliable for detailed sleep staging (light, deep, REM).

• Sleep architecture requires EEG-based measurement, which consumer wearables do not directly measure.

• Over-interpreting sleep scores can negatively affect perceived sleep quality (“I felt great until I saw my score”).

• Wearables are best used as trend-tracking tools, not diagnostic devices.

• Subjective experience (how rested you feel, daytime function) often correlates better with meaningful sleep outcomes than wearable metrics alone.
• Microphone-based apps (e.g., snoring or movement detection) may help identify red flags such as: Loud snoring, gasping or choking sounds, excessive nighttime movement
• These apps cannot diagnose sleep disorders but may prompt appropriate referral for formal sleep testing.

Pittsburgh Sleep Quality Index (PSQI)

• • Well-validated, widely used tool assessing sleep quality and disturbances.
  • Requires scoring interpretation but useful for baseline assessment.

QQRT assessment based on Dr. Matthew Walker's recommendations

• Restless legs syndrome, Obstructive sleep apnea, Insomnia patterns
• https://www.sleepdiplomat.com/qqrt-assessment

Questionnaires provide a low-cost, accessible, evidence-based complement to wearable data.

Core principles emphasized:

• Consistent wake time

• Morning light exposure

• Exercise earlier in the day (ideally ≥2–4 hours before bedtime)

• Avoid late-day caffeine

• Establish a 30–60 minute wind-down ritual

• Reduce light exposure (especially overhead and blue light)

• Avoid late meals (ideally finish ≥3 hours before bed)

• Lower ambient temperature to support core body cooling

• Remove clocks and bright LEDs from the bedroom

• Limit bed use to sleep and sex only

• Journaling or “brain dump” before bed

• Breathwork (e.g., box breathing)

• Progressive muscle relaxation

• Meditation or low-stimulus reading (non-screen)

• Cool, dark, and quiet bedroom

• Breathable bedding rather than heavy comforters

• White noise or consistent background sound for some individuals

• Individualized strategies for sleep partners with differing needs

Key Topics & Takeaways

1. Wearables & Sleep Tracking
2. Phone Apps & Audio-Based Monitoring
3. Validated Sleep Questionnaires
4. Sleep Hygiene: Building Better Sleep
5. Daytime Foundations
6. Evening & Bedtime Routine
7. Mental Quieting Strategies
8. Optimizing the Sleep Environment

Fact Check & Clarifications

- Wearables show moderate agreement with polysomnography for total sleep time and sleep vs wake, but poor agreement for sleep stage classification, especially REM and deep sleep.

- Caffeine can disrupt sleep for many hours after ingestion, with effects persisting into the evening depending on individual metabolism.

-While certain sound frequencies and white noise may improve sleep continuity, evidence does **not currently support 40 Hz stimulation as a proven method to enhance deep sleep.

This episode discusses general sleep science and wellness strategies. Consumer wearables and phone applications are not diagnostic tools and should not replace medical evaluation for suspected sleep disorders.

Hosts: Teddy & Roger
Episode Focus: Understanding normal sleep physiology, sleep architecture, circadian rhythm, and practical strategies to improve sleep quality, health, and performance.

Summary

In Episode 6 of Highpoints, Dr. Teddy and Dr. Roger focus on normal sleep physiology rather than sleep pathology, emphasizing how sleep architecture (light sleep, deep sleep, and REM sleep), circadian rhythm, hormones, and modern behaviors (alcohol, light exposure, exercise timing) interact to influence recovery, cognition, emotional regulation, and physical performance.

Whether you’re training hard, juggling work and family, or simply exhausted and frustrated with your sleep, this episode will help you understand why sleep matters and what actually helps.

What We Cover in This Episode

• What actually happens in your brain and body while you sleep
• The different stages of sleep (REM vs non‑REM) and why they matter
• How sleep deprivation affects reaction time, judgment, and safety
• Why drowsy driving can be as dangerous as driving intoxicated
• The role of sleep in brain recovery and long‑term cognitive health
• How alcohol, caffeine, and light exposure impact sleep quality
• What melatonin does — and what it doesn’t do
• Common myths about sleep supplements and "sleep hacks"
• Practical, evidence‑based ways to improve sleep without over‑medicalizing it

Poor sleep isn’t just about feeling tired. It’s associated with:

• Slower recovery and impaired tissue healing
• Increased injury and illness risk
• Reduced coordination and decision‑making
• Higher accident risk (on the road and in sport)
• Long‑term effects on brain and metabolic health

The discussion in this episode is informed by peer‑reviewed research and clinical guidelines, including:

• Sleep physiology and stages (StatPearls, National Library of Medicine)
• Sleep deprivation and cognitive performance
• Drowsy driving and motor vehicle accident risk
• Glymphatic system and brain waste clearance during sleep
• Associations between sleep and beta‑amyloid accumulation
• American Academy of Sleep Medicine (AASM) clinical guidance on sleep and melatonin

Evidence‑Based References

1. Walker M. Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner; 2017.
2. Watson NF, et al. Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843–844.
3. Lim J, Dinges DF. A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychol Bull. 2010;136(3):375–389.
4. Xie L, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373–377.
5. Killgore WDS. Effects of sleep deprivation on cognition. Prog Brain Res. 2010;185:105–129.
6. National Highway Traffic Safety Administration (NHTSA). Drowsy Driving Research and Statistics
7. Roehrs T, Roth T. Sleep, sleepiness, and alcohol use. Alcohol Res Health. 2001;25(2):101–109.
8. World Health Organization. Alcohol and Cancer Risk Fact Sheet.
9. American Academy of Sleep Medicine. Clinical practice guidelines for melatonin use.
10. Czeisler CA, et al. Bright light resets the human circadian pacemaker independent of the timing of the sleep-wake cycle. Science. 1989;244(4910):1328–1333.

This episode is for educational purposes only and does not replace individualized medical care.